David Anderson: I thank my right hon. Friend for that reply. The whole House should welcome the progress that has been made and hope that more progress will be made this week. Have any specific discussions taken place that will allow the hundreds, if not thousands, of people who have been forced into exile over the past30 years to return to their homes in safety?

Tony Blair: I am sure that the right hon. Gentleman is a lot happier talking about that than he is about policy, but I will talk about policy. I will talk about the policy on the NHS, our policy and his policy, because in the end the issue for the country is who has the right policies for the future, and it is the Labour party that has made record investment in the NHS, which he voted against. It is this party that has delivered better waiting times, improved cardiac and cancer care, better accident and emergency departments, and his policies would put all of that at risk, and that is why we will stick with our policies,not his.

Menzies Campbell: I join the Prime Minister in his expressions of sympathy and condolence to those who have lost their lives since the House last met. We should never forget that each and every one of them leaves behind a grieving family and friends, and we should not forget the thousands of Iraqi and Afghan civilians who have also lost their lives.
	Turning to Northern Ireland, with which the Prime Minister will be engaged later today and for which he has the support of the vast majority in the House,will the right hon. Gentleman confirm that the Government are still committed to the "Shared Future" agenda, which the Government published in March this year and which advocates integration, not separation, for the Northern Ireland community?

Russell Brown: Last month, the hon. Member for Gainsborough (Mr. Leigh) and I visited the Democratic Republic of the Congo, where we saw the excellent work being done by the charity War Child on street children and child soldiers. Today, Amnesty International has expressed grave concern about the number of child soldiers still being held by warlords. Will the Prime Minister guarantee that the Government will put pressure on the new Government in the DRC to take immediate action to get those child soldiers released from the hands of the warlords?

Tony Blair: What Dame Pauline Neville-Jones says is very sensible, and is yet another example of the Conservatives' policy of facing both ways, as she chairs their security commission. The reasons that identity cards are important are simple: 70 per cent. of the cost will be necessary for the new passports in any event; identity fraud and abuse is a major question; and apart from the benefits for the individual in having secure identity, it is impossible to say that we are serious about tracking who is in and entitled to be in this country and who goes out unless there is such an identity system. Therefore, anyone who is serious about dealing with illegal immigration must get serious on the subject of identity cards.

Tony Blair: Yes, but as the hon. Gentleman will know, the reason being put forward for the changes is not that they will diminish community facilities but that they will provide them in a different way—[ Interruption.] I am sorry, but that is a change going on throughout the health service for perfectly good reasons. His petition to me, of which I have read the reports, makes the point about the differential in funding between different parts of the country. It is true, for example, since he has said it in his local newspaper, that there is a 20 per cent. gap between the funding per head in his constituency and that in my constituency, but that is based on the figures for mortality though cancer, mortality through coronary disease and low birth weight. Actually, it is
	"the fact that the most NHS resources should be given to those areas where the disease burden is highest."
	That is a quote from the Conservative campaign document.

Chris Bryant: I do not know whether you, Mr. Speaker, have ever ridden a motorbike. The closest that I ever got was when I hired a Vespa on holiday in Greece. I think that I was the only person in that country to wear a helmet, and I certainly rode considerably more slowly than any Greek person did—even the octogenarian grandmothers carrying 15 chickens on the back of their bikes. However, I know that many bikers derive enormous pleasure from their motorbikes. They describe the sense of excitement and the adrenalin rush in almost ecstatic terms, saying that only a biker truly knows why a dog sticks its head out of a car window.
	I want to do nothing to undermine bikers' sense of enjoyment and excitement, least of all in the Rhondda and the valleys. I know that many bikers come to the valleys because it is an enormously exciting and pleasurable place to go biking. For example, one can go over the Bwlch into the constituency of my hon. Friend the Member for Ogmore (Huw Irranca-Davies), or over the Rhigos, or over into Llanwonno—wherever one goes, there are beautiful places for biking. It is easier if one is on a motorbike rather than a pedal bike, as I know to my cost.
	Part of the thrill of biking is the sense of danger that is attached to it. It is true that in this country two-wheel drivers are 40 times more likely to suffer a serious injury or to die than four-wheel drivers. Some 585 motorcyclists were killed and 6,063 were seriously injured in road accidents in 2004. Motorcyclists represent only 1 per cent. of the traffic in the UK, but 19 per cent. of the deaths and serious injuries. The more we can do to enhance safety and to make sure, for instance, that drivers in their cars look out for motorbikes when they turn on to a main road, the better.
	However, my Bill is nothing to do with those licensed road users. It is about the thousands of unlicensed vehicles, many of them supposedly designed to be ridden off-road. The problem is pretty simple. The law makes it clear that if a bike is driven on the road, it must be registered with the Driver and Vehicle Licensing Agency, taxed and insured, and have a standard number plate, proper brakes, audible warning instruments, brake lights and indicators. The exhaust must also conform and—this is important—must not be too loud or altered in any way. In addition, the law states that the rider must hold a driving licence for that class of vehicle and must wear an approved protective helmet. Furthermore, if the bike is used at night, it must comply with lighting regulations and have lights fitted and working.
	I am sure that all Members would agree that all that is fine and dandy, but, by definition, it applies only to vehicles designed for use on the road, when they are on the road. There is a whole other category of bikes that are not licensed because they are, in theory, designed to be used only off-road. That is where the problem begins. Every evening and every weekend in the Rhondda there are literally thousands of unlicensed, uninsured scrambler and mini-motorbikes on the road. I suspect that the Rhondda is not unique in that and that all hon. Members have experience of that phenomenon.
	In theory, those bikes are only to be used on private land. In practice, they are driven over public land, bridleways and paths, private land without permission and, notably, on the road. Often, they are unsafe vehicles with poor tread and unreliable brakes because they do not have to go through an MOT. Often, they are driven by children—not only under the legal age, but sometimes as young as eight, nine, 10 and 11. Often, they are driven recklessly and dangerously, and as they are often driven by children, it is difficult to expect more. Often, they ruin areas of natural beauty, digging up beautiful areas of the countryside. Often, they are fitted with so-called silencers, which actually make the vehicles louder rather than quieter—something that the industry must work on. In every instance, by definition, they are not insured, so when there is an accident, the innocent party often not only has the problem of the crash, but has to face increased insurance premiums later in the year.
	For people in the Rhondda, that means a deafening racket reverberating around the valleys nearly every evening and every weekend. It means that pavements and roads—especially, for some bizarre reason in cul-de-sacs—become virtual race tracks. All too often, it means that a 10 or 11-year-old is put in charge of a lethal weapon that can go up to 60 mph. I believe that that is simply wrong. One person e-mailed me yesterday to say:
	"In Aberavon on the beach we suffer continually with damage to the dunes and nature areas from motor bike enthusiasts driving at speed over the beach and in the dunes every day".
	The situation is getting worse. According to Revenue and Customs, there has been a twentyfold increase in the number of Chinese-imported mini-motorcycles coming into the UK. The number rocketed from 7,000 in 2001 to 144,000 in 2005, the last year for which figures are available. No wonder that, in Reading,44 per cent. of all calls to the council's antisocial behaviour hotline are to do with mini-motorbikes and the noise that they create. No wonder that Kent police received 4,000 calls about them last year alone. No wonder people complain about the problem at every single PACT meeting in the Rhondda, or that my local chief superintendent, Jeff Farrar, says:
	"the menace of scrambler motor bikes is the biggest single issue ruining people's lives in the Valleys".
	The police have tried all sorts of things. They have tried stopping all the vehicles at the areas where they regularly congregate and arresting the riders in one fell swoop. They have tried providing information about what is legal and illegal. They have tried using new on-the-spot fines legislation, which has been successful, and impounding vehicles. However, their biggest difficulty is that they are hamstrung when they see someone driving a bike illegally. They cannot give chase, because if they did and a youngster came off the bike and was injured, it would be quite likely that the police officer involved would be suspended pending an investigation. Additionally, such a chase would of course be dangerous to the general public.
	The main problem is that the police cannot identify the bikes because they do not have licence plates. That is why I believe that we should license all bikes, regardless of whether they are designed to be driven on the road. The relevant legislation is section 1(1) of the Vehicle Excise and Registration Act 1994, which says:
	"A duty of excise...shall be charged in respect of every mechanically propelled vehicle which is used, or kept, on a public road in the United Kingdom and shall be paid on a licence to be taken out by the person keeping the vehicle."
	The provision should be amended so that it covers not just on-road vehicles, but all off-road vehicles.
	Who supports the proposal? The British Motorcyclists' Federation does, with its 130,000 members, as does the Trail Riders Fellowship. The Greater Manchester police authority supports it—I am sure that many hon. Members' police authorities do—and has been calling for such a scheme for a while, as has my hon. Friend the Member for Telford (David Wright), not least because a friend of his was knocked down on a piece of open land by an unlicensed, unidentifiable bike that drove off. The fact that the bike had no number plate meant that it could not be tracked and justice has thus not been done. Licensing is notthe only thing that we should do. I have mentioned the noisy silencers, and it must be time that either the industry acts to make biking quiet, or the Government take action to ensure that everyone can enjoy their right to a peaceful existence.
	We must accept that many local authorities have been slow to make proper legal provision for bikers. As one constituent wrote today:
	"if proper motor cross tracks are made this will stop 90 per cent. of people riding where they shouldn't"—
	I agree. Proper, well-designed tracks in areas where noise will not impinge on the local population are vital if we are to win the battle. Biking is a great sport—I am sure that my right hon. Friend the chairman of the party agrees—but the illegal use of scrambler and mini-motorcycles is bringing biking into disrepute. It is time that we abolished the false distinction in law between on-road and supposedly off-road biking.
	 Question put and agreed to.
	Bill ordered to be brought in by Chris Bryant, Jessica Morden, Philip Davies, Anne Snelgrove, Ms Barbara Keeley, Rosie Cooper, Mrs. Madeleine Moon, David Wright, Mr. Iain Wright and Mr. Tom Watson.

Andrew Lansley: I will carry on for a minute. I have taken an intervention and I have yet to get on to the issues that we really need to reach.
	We need to understand that all the deficits are having major consequences for staff. As I said, we might have imagined that, at the same time that jobs in hospitals were being cut, they were being created in the community. Members will recall that back in January, a White Paper was published the purpose of which was to state that precisely that shift of patients would happen. Well, what do find? The work force census showed that in the last year for which figures were available, there were 485 fewer health visitors, 760 fewer district nurses, and even 36 fewer midwives. Yet the Government seem to think that those people are somehow magically going to increase in number and be available to provide services.
	The Prime Minister made a speech on this issue last month. The action plan for social exclusion says that all additional health visitors and community midwives will be upskilled in order to undertake early interventions with families. Health visitors in my constituency used to visit every family, but that service disappeared about seven years ago. There simply is not the number of health visitors to enable that to happen.

Andrew Lansley: No; I am carrying on for a bit.
	I do hope that the Secretary of State will also make it clear that, wherever possible, such posts will be run-through training posts that give the junior doctors concerned greater assurance that they can qualify and get their certificate of completion of specialist training in due course.
	It is not only doctors who have problems. As the Royal College of Nursing made clear in its surveys, many nurses are leaving college unsure that they will find jobs; indeed, many do not find jobs. In some cases, half or more of the graduate output do not find jobs. Some 100,000 nurses are due to retire in the next five years, and over the next three years there will be a20 per cent. reduction in the number of nursing training places. What are the prospects for nurses? I met a nurse in my surgery just last Friday, who said:
	"I have just qualified as a nurse, and finished my degree in children's nursing at the beginning of July. I have been applying for jobs since May and am still unemployed...for one interview I attended, 45 candidates were being interviewed from over 120 applications. I am at a loss to know what to do."
	I also received a copy of the following letter from a lady, who writes:
	"My daughter will qualify as a psychiatric nurse in August after three years of training...She and her fellow students have been informed that there will be no training posts for them in Cornwall on qualification...The situation now is that she will not have a job in the Health Service within her chosen profession. And she will not be able to find employment abroad without one year of post qualification training."
	Let us consider physiotherapists. How many Members present met members of the Chartered Society of Physiotherapy when they came here in July? Well, I met the students from the Royal London: 99 students completed the course, but only one has a job.
	A lady writes to me:
	"My daughter is one of hundreds of newly qualified physiotherapists unable to get a job because of the crisis in the NHS...My local hospital has a waiting list of 10 months to see a physiotherapist."
	Somebody writes from Norwich that of 96 students leaving physiotherapy training only five found jobs. A letter from Lincolnshire states:
	"Not one student from Nottingham (which is a centre of excellence for physiotherapy) has been able to find employment as a physiotherapist in the NHS. This abysmal situation appears to be directly due to the budget deficits across the NHS."
	I have a question for the Secretary of State, because a practical issue is involved. In Scotland, as sheknows, the Scottish NHS guarantees nurses and physiotherapists a year of employment following their graduation. Will she say that the same thing will happen in England?

Andrew Lansley: I do not want to take more than about half an hour as many Members want to speak.
	Deficits do not affect only trainees; they have a direct impact on existing specialists. A report suggests that, by December, 61 cardio-thoracic surgeons will be without a consultant appointment in the NHS. I am advised that 37 ear, nose and throat specialists do not have posts at present. The Royal College of Anaesthetists tells me that whereas in previous years there have almost always been about 30 advertisements a month for new anaesthetist posts—last year there were 31 in July and 29 in August—only 17 were advertised in July this year and only four in August. The president of the royal college rightly says that a great number of people in other countries are looking for anaesthetists. My concern is that if we make life difficult for too long, they will go; we will lose the specialists we need.
	The Government should note that the British Orthopaedic Association has already told them that the average retirement age of orthopaedic surgeons has gone down by three years over the past seven years. Such is the extent to which we are losing services.

Andrew Lansley: My hon. Friend is absolutely right. The situation for stroke patients, for example, is utterly depressing. Even if they are able to secure early and intensive rehabilitation, sometimes treatment cannot be followed up to maximise their chances of recovery, due to the lack of physiotherapists in post. We must have more physiotherapists. The Government said that we needed more physiotherapists and that there would be 60 per cent. more. People went into the profession as a result. A physiotherapist told me: "I knew what was intended so I went into the course. Now there are no jobs." That is a deeply depressing fact; it is a cruel irony played on people who took up such courses.

Andrew Lansley: No, I am sorry.
	Not only have we lost specialist posts but training budgets are being cut. The Secretary of State might like to tell us whether it is the case that, as reported, training budgets across the country will be cut by10 per cent. this year. She might like to consider the example of Leicester where the strategic health authority says that it will cut £52 million from the training budget. The University Hospitals of Leicester NHS Trust told Leicester university that it will cut clinical academic funding by 20 per cent. That will mean the loss of 15 per cent. of the medical school staff, who spend more than half their time treating patients. Some of the senior staff, who are integral to the trust's delivery of service, will be lost.
	To be fair to the Government, in 2002, they introduced the GP returner scheme and 550 GPs used it, but the money has disappeared. In 2006-07, there will be no money for the scheme; it is disappearing across the country.

Andrew Lansley: No, I am not giving way, as I am moving towards my conclusion, but before I do so, I want to be fair to the Government. We are talking about work force planning and because I wanted to understand the Government's approach towards it, I looked at their evidence submitted to the Health Committee, which is currently investigating the matter. Here it is. The Government say that there is now "a streamlined framework" for work force planning. There are workforce directorates within strategic health authorities and they work with the social partnership forum, with the workforce programme board, with the national workforce group, with the workforce review team, with NHS national workforce projects, with Skills for Health and with NHS employers. There is even a diagram to explain it all—and all that is supposed to be the "streamlined" framework! Whatever it is, it is certainly not yet streamlined enough. We need a much better system because out there in the NHS, staff have no idea what the work force plans look like, as even now, posts are being cut.
	The staff of the NHS are, as we have said, its greatest asset. They work miracles daily and we need them to be motivated and inspired, but at the moment they are demoralised. The Secretary of State has gone from her "best year ever" in May to a "very difficult year" by September. NHS staff are seeing a feast turn into a famine. They see promises of expansion turn into cutbacks and they see the advertising campaigns of three or four years ago to recruit new nurses and therapists turning into the cruel irony of people leaving training unable to pursue their vocations and findjobs. They see sham consultations over service reconfigurations driven by short-term financial expedients.
	The staff also note how the effects of the European working time directive are dressed up to suggest that services have to be shut down because they are deemed unsafe. Frankly, that is a slur on NHS staff. People are working across the country to save their local NHS services. Labour Members should not decry that as a Tory conspiracy; it is happening because people are angry about the loss of their local NHS services. They do not want to block changes, but they want them to be guided by evidence and to take account of needs for accessible services.
	The new chief executive of the NHS says that more than one in four of district general hospitals have to be downgraded. He then tells us, in an interview in  The Guardian, that he "understands the politics" of it. Well, we do not need an NHS chief executive who understands politics, but one who is focused on patients. We need a chief executive who is not spending all his time trying to work out what Ministers want him to do, but assessing what is in the best interests of patients and the NHS. We need an NHS free of the Secretary of State and the chairman of the Labour party sitting down with their advisers, trying to decide which hospitals to close.
	I am an optimist. I believe in the NHS and I believe in what NHS staff can achieve, but they can do so only if we give them the framework, the resources and the freedom to deliver. That is our objective, so I commend the motion to the House.

Patricia Hewitt: I want to make some progress before giving way again.
	I also want to thank NHS staff for dramatic improvements—belittled, I have to say, by the hon. Member for South Cambridgeshire—in cancer care. I do not think that any of the 50,000 cancer patients who are alive today because of improvements in cancer care would want to belittle them and neither would the hon. Gentleman's view be shared by cancer patients who have seen dramatic improvements over the last 12 months. Just 12 months ago, fewer than seven out of10 patients with most suspected cancers could count on being seen, diagnosed and then beginning their treatment within two months. Today, nearly 95 per cent. of patients are doing so. That is the result of the incredibly hard work of staff, more money, which the Conservatives voted against, and the targets set for cancer care that the Conservatives would abolish.

Dari Taylor: On that very point, I would greatly appreciate it if my right hon. Friend would keep certain facts to the forefront of the debate. In North Tees hospital, for example, 100 per cent. of all breast cancer patients are seen and treated within 62 days. That is a superb achievement, on which no one in the House should ever do anything other than congratulate.

Patricia Hewitt: First, as the hon. Gentleman knows because I have written to him on this point, I have already ensured that the Nuffield speech and language unit—an issue that he has specifically raised on many occasions—will continue to treat patients. [Hon. Members: "What about the vale of Aylesbury?] Funding for the Vale of Aylesbury primary care trust has increased by more than 30 per cent. over the past three years, by £40 million. In Buckinghamshire PCT, over the next two years, there will be an additional £91.5 million. However, what we must do—Opposition Members refuse to accept this—is support the NHS in making decisions that are often difficult, to get better value for that money, to release the savings that it needs to pay for more speech and language therapists, for new drugs and for all the other services that need improving. The hon. Gentleman is not willing to accept that, any more than are other members of the Conservative party.

Andrew George: Although I do not doubt the Secretary of State's sincerity, I hope that she will visit Cornwall to see for herself the impact of the reforms that she and others have been implementing in areas such as my constituency. Despite the protestations that her Department is not enforcingthe diversion by local trusts of NHS resources into the private sector, is she aware that, in fact, patients who are facing unnecessary, enforced minimum waits, including waits of more than nine weeks for breast care at the moment, receive unsolicited calls from NHS managers inviting them to be seen sooner in the private sector? Will she come to Cornwall to see the results of those reforms and their impact on the financially hard-pressed service there at present? In fact, it is a financial mess. People are waiting unnecessarily and the money is going into the private sector instead.

Patricia Hewitt: My hon. Friend the Under-Secretary of State for Health will indeed shortly visit Cornwall; I hope to do so in the near future. There are indeed some real challenges in not only the hon. Gentleman's constituency, but across Cornwall, in ensuring that the enormous amounts of extra money that we have put into the NHS in his part of the country are used to the best possible effect to ensure that patients get the best and fastest care everywhere. However, the NHS in the south-west has made superb use of the independent sector—for instance, at the Shepton Mallet treatment centre—to speed up the treatment of patients who need orthopaedic operations and to do so in co-operation with the rest of the NHS in an integrated fashion.

Patricia Hewitt: Just let me answer—[ Interruption.]

Andrew Lansley: The Secretary of State is not addressing the questions in the debate, but the issue is simple and we take exactly the same view as the NHS Confederation. Resources that are being allocated across the country to deal with health inequalities and that should be directed towards public health measures should be in separate budgets from resources allocated in relation to the burden of disease in an area in order to ensure that there is equitable access to care.
	The principles that we set out on Monday are very clear and involve equitable access to service delivery so that we do not arrive at the position—it happens now—whereby I can stand in the stroke ward in Luton and Dunstable hospital and be told that there are two kinds of discharge arrangements. The first is for patients going to Luton where the PCT has enough money to provide follow-up and rehab and the other is for Bedfordshire Heartlands, which is in deficit and cannot provide those services. That is not fair to patients.

Patricia Hewitt: I will not give way as I want to make progress.
	The Conservative party has told us this week that it wants an independent commissioning board completely free to decide where patients should be treated, but it opposes any change in NHS provision, including, it appears from one Conservative Member, the involvement of Age Concern in providing some services. It says that it wants to put decisions in the hands of NHS professionals but, every time the local NHS proposes to make a change in the organisation of services, members of the Conservative party are out marching in the streets to oppose it. They protest—they have been doing it again this afternoon—against every closure of a community hospital.
	Conservative Members should go to Norwich and talk to Tony Hadley, the brilliant nurse manager whom I met recently who worked with his nursing and community team to reorganise community hospital services. They cut the number of community hospital beds, they closed some wards and closed two community hospitals and centralised them in a third. Conservative Members are out on the picket lines when anything like that is proposed in their constituencies, but what Tony Hadley and his team did in Norwich was to listen to patients who want to be cared for at home rather than in hospital and they put half the staff out of the community hospital and into the community itself. They doubled the number of patients that they could care for, they slashed the number of emergency admissions and they saved £1 million a year that can go into better care for other patients. The Conservative party has to decide whether it is for or against that.

Stephen Dorrell: May I suggest to the hon. Gentleman, with respect, that he leave the Government's propaganda to the Government? He is looking at the Division list on a national insurance tax increase and linking the £8 billion that was the result of that tax increase to increased NHS expenditure. That is the Government's line, but it does not need to be the Lib Dems. If he looks at the Budget for that year, he will find that the biggest single increase in public expenditure in the year in which that Bill raising the money to pay for it went through, was not for the national health service at all. The biggest single increase in public expenditure that year went into the social security budget, so why does the hon. Gentleman feel it necessary to accept the branding that the Chancellor of the Exchequer attached to a tax increase in order to make a spending increase on social security sound more acceptable by saying that it went into the national health service, when it did not?

Chris Ruane: I thank the hon. Gentleman for raising the crucial issue of financingthe NHS. The hon. Member for Peterborough (Mr. Jackson) referred to the period between 1979 to 1997, when expenditure under the Tories went up by60 per cent. May I remind the House that from 1997 to 2008, under Labour, the budget will be going up by300 per cent.?

Steve Webb: Nobody could dispute that the rate of increase in spending under the present Administration since 1997 has been substantially in excess of what the Conservatives did or would have done, had they been in office. I am glad the hon. Gentleman mentions 1997. Part of the reason that I am addressing the House now is the record of the Tories on the NHS. In 1997, I had people coming to see me at my surgery with letters from their hospital stating that it would be two years before they could see an orthopaedic consultant to be put on the waiting list.
	The reason that Conservative Members object to my raising that and think we should be attacking solely the Government is that the Conservatives are portraying themselves now as the friends of the NHS. I find that laughable. They have form. They have form in cuts in their final year in office, they have form in voting against money for the NHS, they have form in the patients' passport, and only last month the Conservative leader took out from the first draft of his speech a line that pledged to match Labour's spending on the NHS. What was that about? If the hon. Member for South Cambridgeshire (Mr. Lansley) wants to reinsert that pledge on the record, I will give way to him.

Steve Webb: So the hon. Gentleman does not rule out spending less than Labour on the NHS.
	The hon. Gentleman said at the start that the debate was not principally about finance. One of the reasons that there are 90 per cent. unemployment rates among physiotherapists when they graduate, and one of the reasons that we are seeing redundancies, including of front-line medical staff, is the Government's mismanagement of the finances of the NHS.
	A recurrent problem throughout the debate is the issue of reconfiguration and who should decide when health services need changing for greater efficiency. At Prime Minister's questions earlier today, the hon. Member for Hastings and Rye (Michael Jabez Foster) said that, if we do not like what is to happen to our accident and emergency department, who do we ask? What do we do about it? There is only one person who has been anywhere near a ballot box whom people can ask, and she is sitting on the Government Front Bench.  [Interruption.] The Secretary of State says overview and scrutiny. The local authority can scrutinise. What does it have the power to do? It has the power to go and ask her, and if she wishes and deigns to do so, she can refer the matter to an independent body.
	My overview and scrutiny committee asked the Secretary of State to review the closure of Frenshay hospital in my constituency. Guess what? She refused. All three parties on the council, not just the Liberal Democrats, wanted a referral. I want a referral. Anyone who had ever been elected in the area wants a referral, but the Secretary of State blocks it, so she is the one who controls these matters centrally. How is that a democratic and accountable national health service?

Steve Webb: At the risk of being parochial, there is the strange coincidence that the hospital in my Liberal Democrat-held constituency closed so that a new one could be built in the neighbouring Labour-controlled constituency. We need to know that the difficult decisions that have to be made are being made on clinical grounds. All too often, it seems blindingly obvious that other factors, shall we say, come into play.
	The Government and the health service must treat the public as adults and give them the necessary information and the opportunity not to be consulted and ignored, but consulted and listened to and for their views to be acted upon. I have discovered a new word in the English language—it is sham-consultation. We cannot have the word "consultation" any more without the adjective "sham" in front of it. Throughout the country when I, like the Secretary of State, visit local people, they say, "Yes, we went to endless consultation meetings, we had engagement, then consultation, then review, and then all the rest, but in the end they did what they were always going to do."
	If people are making decisions against the will of the local people, they should be people who local people can get rid of. How can it be right that decisions affecting hon. Members' health services are made by people whom they never elected, whom they can never get rid of, and whose only right of appeal is to the Secretary of State—who has total discretion to ignore the appeal and, if she hears the appeal, can refer it to a quango, which we also did not elect? Where is the democratic accountability in that?
	I have some sympathy with the idea of getting rid of centralised meddling, so to that extent I am with the Conservatives on the idea of independence, but it falls down because there is no democratic accountability, particularly at the local level. Local communities are frustrated because they feel that the decisions are being made for them, rather than with them. Lots of meetings take place, but how often do they change anything? That is one of the things in the health service that must be changed.
	The Secretary of State met the press this morning. She is anticipating whatever the Healthcare Commission might find tomorrow about the health service's performance. She said that we need action plans. In other words, where PCTs are found to be weak we urgently need action plans to start within a month. That typifies the Government's mismanagement of the NHS. She does not say that we need long-term strategic thinking for efficiency over a period of years or that we need deep-seated financial problems sorted out in the medium term, but that we anticipate a bad headline tomorrow, so we need an action plan and we have a month—a month—to do things that presumably have not been done for the last nine years. Is that a month to put long-term plans in place; a month to consult and listen and refine? No, just a month to get them out of the mess they are in this month.
	What is happening with NHS finances is that problems that have built up over years, decades in some cases, have to be sorted out by Wednesday week. How can that be a rational way to run the health service? We have huge financial instability. The Secretary of State complained that the Tories wanted to spend taxpayers' money subsidising the private sector. The words "pot", "kettle" and "black" spring to mind. Independent sector treatment centres are being given better prices than the NHS, guaranteed volumes of delivery, the chance to cherry-pick the easy hips, cataracts and scans, but at the expense of what? She mentioned the ISCT at Shepton Mallet, but that has resulted in job cuts at the Royal United hospital in Bath just upthe road. Frenshay hospital will virtually close and the chances are that an ISTC will be built on the site, so the same people will be having the same procedures onthe same site but done by the private sector instead of the public sector, probably at greater cost—and that is not privatising the NHS? I wonder what would be.

Steve Webb: My hon. Friend raises some very strange matters that are occurring in the NHS. I assume that the Secretary of State knows what is happening. We are supposed to have patient choice. The patient is supposed to see the GP, go through a list on the screen, pick one, and then a booking is made—except that someone is tapping the phone line. Someone intercepts the call, second-guessing the GP's referral, and in some cases saying, "Are you sure you want to do that? Let's try to refer them somewhere else." How that squares with patient choice I am not sure. If the GP and patient jointly decide one course of action and that is second-guessed, I do not see how that is patient choice.
	My hon. Friend referred to minimum—not maximum—waiting times. We have examples all over the country—my hon. Friend the Member for Twickenham (Dr. Cable) has raised the matter with me—of people being told that they have to wait longer because there is no target at the bottom end. The people right up against the target will have priority, even if the others could be treated sooner because there is no target. Those are the sort of distortions that the Government's obsession with targets are creating inthe NHS.

Steve Webb: The hon. Gentleman represents a seat north of the Watford gap, and he is right that we need to spend every penny wisely. Every incoming Government say, "Vote for us and we will spend the money more wisely", but the issue goes deeper than that. The Conservative party is saying that it would spend more money in the south of England without ever saying that it would spend less in the north. The shadow Secretary of State has said that the Conservative party should regard public health money as one pot and money for illness as another pot. Those two areas are clearly separate, but the total will not change—if one area gets more, another area mustget less.

Kevin Barron: Not just yet.
	We could then have had a discussion about the apparent conversion that has taken place in the past six years in terms of the money spent in the national health service, and how services have kept expanding while being paid for out of the public purse and not through private insurance.
	I intervened on the hon. Member for South Cambridgeshire (Mr. Lansley) to draw attention tothe extraordinary statement by the Leader of the Opposition on Monday, quoted again in the Conservative website news story:
	"So my message to the Government is clear: the NHS matters too much to be treated like a political football."
	Wonderful stuff, is it not? I also have the Conservative party's NHS campaign pack, which, I understand, is about to appear on its website— [Interruption.] It is not entitled "save the NHS", although I may sign up to one or two things in it, and I am prepared to share a few views about it with hon. Gentlemen. It is to be launched on Saturday by the Conservative party—I presume that it will be the non-political health service football that will be launched. That pack is very good and includes materials that can be purchased for action day, graphics to download and a template press release. All people have to do is take out the italics and put in how awful the NHS is in their part of the country.  [Interruption.] Conservative Members who are making noises will find it very difficult to come to my part of the United Kingdom and fill in any type of press release saying that about the NHS there. I challenge them to come and do that on Saturday, although I will be holding a surgery.

Kevin Barron: Further to that press release—[ Interruption.] I will let its author speak in a few minutes. It is different from the motion in subtle ways. It includes a template for a council motion to be tabled at local government level, again to try to get everybody to agree how awful the NHS is. Once again, it will be a struggle to fill that in in south Yorkshire. None the less, although that press release says that almost 20,000 jobs have been lost from the national health service, the motion does not do so—it refers to posts. All of us who want to share the truth about such matters know that nowhere near 20,000 jobs are being lost in the national health service—not in the last 12 months, two years, three years or anything else. There are more than 80,000 additional nursing jobs in comparison with10 years ago, and many other grades have more people working in them.
	We received an e-mail from NHS Employers alluding to this matter, some of which was quoted by the hon. Member for South Cambridgeshire. That e-mail stated:
	"Last week, NHS Employers contacted 18 trusts which had identified potential redundancies. Across all the organisations, the original estimate of the number of posts to be lost was 7,900, with the DTI subsequently notified of 3,999 jobs at risk. The number of actual redundancies (voluntary and compulsory) is 766. Of these 540 are in two organisations"—[ Interruption .]
	I will go on, because the hon. Member for South Cambridgeshire missed all that out—clearly, he just picked up the second page when it came out of his printer. The document continued:
	"The figures being widely quoted of up to 20,000 may turn out to be not too far off the total reduction in workforce numbers this year. This applies, however, not to people being made redundant but to the number of posts being taken out of the system in a total workforce of some 1.3 million which experienced an increase of 268,000 during the previous six years."
	That has not stopped the Conservatives saying in their petition to councils that there have been 20,000 job losses in the national health service. I shall ask my party if it will produce a motion for our councillors to take to their council chambers, which says that those are not job losses in the real sense.

Kenneth Clarke: When my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) began his excellent and thoughtful speech at the start of this debate, he was accompanied by the usual cacophony of noise that we hear in every debate we have on the health service, with people briefed by the Government Whips Office denouncing us for treating the health service as a political football. I find that recurrent atmosphere ever more remarkable, because we are steadily moving towards a consensus in principle on the health service, of a kind that I never thought I would live to see.
	We are all in agreement about the principles of the national health service. I have consistently believed that it should be provided free at the point of treatment, according to clinical need and largely funded out of taxation. The final loophole is only for prescription charges and so on, which we have always had in the system. I actually agree in principle with the reforms that the Government are introducing, because they are remarkably like the reforms that have been embarked on for the past 20 years.
	I was delighted to hear the hon. Member for Hackney, South and Shoreditch (Meg Hillier) give an explanation of how the health service has always been a partnership between the private sector and the public sector. Her views would have seen her drummed out of the Brownies 10 years ago if she had said anything of the kind from the Labour Benches. Her predecessor, who was a very left-wing Labour MP, has now joined the Liberal Democrats, who are the last defenders of the view of the old left opinion that provision by the state of the buildings, staff and everything else is a key part of the system.
	We are all embarked on what I never really thought was a market system, but has been called the internal market. It is a market-influenced approach, in which there will be a wider variety of suppliers, including the independent sector with the state-owned and provided hospitals, and in which patient choice is brought into play because it gives rise to competition and cost control and directs taxpayers' money to those places with greatest public demand because of the quality of service provided. In that way, the system reflects public need. That is our destination, but we are now in the middle of a familiar debate in which each side hurls at the other allegations about the acute crisis that weare in.
	My principal complaint about the Government is that having had their miraculous Pauline conversion about four years ago, they have so far embarked on the process of reform in such an incompetent fashion that they are in danger of giving it a very bad name. They are in the middle of a classic crisis of the sort that my right hon. Friend the Member for Charnwood (Mr. Dorrell) and I are only too familiar with. The Government do not even understand how they got there and they are in denial about the financial problems underlying the present situation.

Kenneth Clarke: In a moment.
	I heard the Secretary of State using phrases that I remember using frequently when I was closing hospitals that we did not need. In my day, they were often Victorian workhouses. I would explain how we had to strive for more day surgery, shorter stays in hospital and more use of community services. That is all common sense when running any health care system. The snag is, as has been illustrated over and over, that that is not at the root of the present bad crisis. At the moment, many parts of the country—including mine—are being driven to short-term expedients to address financial deficits. They are saving money wherever they can. The failure to offer jobs to physiotherapists has nothing to do with a movement towards a more rational service. Student nurses are having more difficulty finding jobs and clinical staff are being shed because the NHS is in a total shambles. If the Secretary of State will not acknowledge that, we do not have much chance of curing it. I preferred my hon. Friend's approach.
	The crisis is caused, as crises in health care systems throughout the world are caused, by a complete inability to control costs; the complete lack of a financial management system for most of the NHS; and an inability to localise the services sufficiently and give enough discretion to the people with the competence to sort them out, if that is what they wish to do.
	I accept that there is no shortage of resources. The tragedy is that the crisis has occurred after the Government have poured money into the NHS forthe past 10 years. That is not a matter of pride. How can they have trebled the expenditure in cash terms and doubled it in real terms, but still need to sack staff or close hospitals all over the place because costs have not been controlled? The Government cannot answer that question.

Kenneth Clarke: No, as I am afraid that I have a time limit.
	The NHS is the largest employer in western Europe, but Ministers must resist the temptation to make political claims about how many new jobs are being created. They must have regard to what the extra staff are being employed to do, whether they can be afforded, and how the system is being allowed to proceed.
	In my day, pay negotiations were very difficult. Ministers of State used to have to get stuck in, because no one on either side of the House could be persuaded that the affordability of pay increases was something that had to be borne in mind. What has happened since then? The working time directive has been allowed to go through, and there has been a huge increase in the number of doctors. The 24-hour commitment of GPs has been abolished, and all nursing grades have been raised as a result of people writing their own descriptions of their responsibilities. Lots of other staff are now employed, and we have the best paid clinical professions in western Europe. I congratulate the BMA and the RCN: as usual, they have taken the Department of Health to the cleaners, but what were Ministers doing when all that was happening?
	The NHS has no system of proper financial control. We all believe in a giant NHS run on principles that everyone accepts, but there must be a system of financial control. All other giant organisations—such as Marks and Spencer and BP, although they are smaller than the NHS—have that. I can think of no other business-like activity whose first thought is to cut back its service, or product. The health service goes running around closing wards because it cannot afford the staff to keep them open. It closes community hospitals and stops recruiting the necessary trainee staff, but none of those problems has been addressed.
	Of course, those are not comfortable things for me to say. I might have to mute some of it at the next election, as the news that not all problems will be solved merely by getting rid of the present Government is not always welcome to a general audience. However, my hon. Friend the Member for South Cambridgeshire is trying to depoliticise and localise the argument, and that approach is absolutely essential.
	The only way to manage the NHS is through more, and genuine, local budgeting and financial control. People will have to stick to their local budgets, but they will have discretion about how they spend the money. We are getting GP fundholders back, but I have yet to discover whether they will have real budgets and total discretion about where they spend their patients' money in the service. All that has to be tackled, but what we do not need is more mad structural change all the time.
	The Government have failed to manage the changes that their reforms require—of course the pattern of service has to change, but they are not even controlling the pace of change. It is crazy to go backwards and forwards on PCTs, commissioning, budgeting and so on, because that just demoralises the people who should control things. That is a failure on the Government's part. They are in a crisis, and they need to start again and decide how they are going to reform the NHS.

Neil Turner: I begin by declaring an interest, in that my wife is a member of the Wigan and Leigh hospital trust board. I am amazed at the brass neck displayed by Opposition Members in holding a debate on the NHS. They seem to forget some of the problems that existed in 1997. They do not like to hear what they were, but it is important to put what is happening in context.
	I remember workers throughout the country holding a one-day strike to support nurses, who did not want to go on strike and therefore disrupt the services that they were providing. Other workers were prepared to give up a day's work to support the nurses, to whom the then Conservative Government did not want to pay a proper wage.
	I also recall the winter beds crises that arose year after year. Patients were forced to use trolleys in hospital corridors or were bused all over the country in ambulances. People were even treated in ambulances in those days, but such things do not happen now.
	Two years was the norm for waiting lists throughout the country in 1997, but nowadays the maximum wait in Wigan in six months, and the vast majority of cases are dealt with in three months or less. I remember having to wait in an accident and emergency department in Wigan for more than eight hours before I was seen, but every patient is now dealt with inside a maximum of four hours.
	All that represents a dramatic change from what was happening in 1997, and it would have been nice to hear an apology from Opposition Members for that. Given where the Leader of the Opposition was on Black Wednesday, I suppose we should expect him to say, "Je ne regrette rien." However, instead of saying, "We regret nothing," what we get is the Opposition saying, "We forget everything." Well, neither I nor the people of Wigan have forgotten, and we will make sure that the people of Britain do not forget when the next election comes around.
	What are the Opposition's policies now? In 2005, as we have heard, we had the patient passport, which would have put wads of money into the private sector. In 2006, we have the Leader of the Opposition on his webcam telling us how good it is to wash up dishes, although I not sure what that says about him. The Conservative spokesperson on health says that his party does not want any more reorganisation, but that there will be a new organisation to reorganise things. He also says that there will be no more targets, but that his party will introduce protocols instead. The Opposition are all over the place: we have gone from flog it to blog it to blag it, but not one Conservative Member has shown any sign of embarrassment.
	I want to tell the House what is happening in Wigan. The Wigan PCT and acute hospital trust covers Wigan and the constituencies of Makerfield and of Leigh, and parts of Worsley and West Lancashire. I am sure that my right hon. and hon. Friends who represent those areas—and they are friends as well as parliamentary colleagues—will not mind too much if I stray into their territories.
	Since 1979, we have some 400 extra nurses and 100 extra doctors in Wigan. In the past two years, we have recruited 20 extra GPs, and 14 extra matrons are working in the community. Just as importantly, huge capital investment has been made. There are new maternity, neonatal and intensive care units at the Royal Albert and Edward infirmary, as well as a new X-ray department with a magnetic resonance imaging facility. The hospital as a new endoscopy unit, and extra beds. In case some of what I have listed does not work, the hospital also has a new mortuary.
	At the Wrightington hospital in the Wigan area—where hip replacements were originally pioneered—there are two new clean-air orthopaedic clinics, while other wards have been refurbished and upgraded. Moreover, the Thomas Linacre centre is a brand-new outpatient facility in the centre of the town.
	Over the recess, I visited the new cardiac catheter laboratory that has opened in the Royal Albert and Edward infirmary, and the new patients information centre at Wrightington. I also went to the renal unit opened under Wigan's LIFT—local improvement finance trust——programme. Never has one so well gone to so many health units in so short a time.

Grant Shapps: We are all delighted for his constituents in Wigan, but how does he think that my constituents in Hertfordshire will feel? They were promised a hospital worth £500 million before the election, when a health Minister represented the seat that I now occupy, but the hospital has been withdrawn now that the election has passed. I understand the party political points that he makes, but how does he explain the fact that 18 years of so-called Tory cuts in the NHS meant that my constituency had the QE2 hospital, with accident and emergency, maternity, paediatric and other services? They have all been stripped away. The news is good for people who happen to live in Labour constituencies, but blooming bad for those who did not vote Labour. The Government's policies are a punishment, are they not?

John Bercow: The hon. Gentleman is positively triumphalist about the position in Wigan, but how does he explain the contradiction between the fact of greatly increasing expenditure nationwide on the one hand and no comparable increase in national health service productivity on the other?

Nicholas Soames: Jollygood try.

Neil Turner: Thank you. I thought that it was fairly successful, as well.
	Not only do we have renal units, diabetes is being treated in the community. People who have heart disease are being treated in their own homes, although obviously not while they are having their operation—I would not suggest that for one minute. The post and pre-operative aspects are being dealt with in people's own homes. Cancer therapy is being delivered at home. There are smoking cessation clinics in the clinics that I mentioned. In the case of dental treatment, there is an emergency line that operates 24/7 for the whole of the borough. That shows a shift from secondary care to primary care when dealing with health. It is not just a matter of some kind of organisational shift; it is what patients need and want, and what we are delivering.
	I will finish—I am well aware that many people want to speak in the debate—by giving my constituents a strong warning. What we heard from a number of Members, and particularly the hon. Member for Northavon (Steve Webb) and others who talked about the campaign pack from the Conservatives, was that that pack provides a stark warning. The Conservatives will move resources from Wigan to Windsor, from South Kirklees to south Cambridgeshire, and from Leicester to Leominster—from places that need those resources, because health there is poorer, to places that do not need them, because health there is better. Resources will no longer be based on health needs. They will be gerrymandered yet again to Tory areas. If anybody in Wigan votes for the Conservative party at the next election, they should know what they are voting for.

Stephen Dorrell: I want to respond briefly to the point with which the hon. Gentleman closed. It has been apparent several times in the course of the debate, listening to Members on the Front Bench, as well as the Back Benches, that the charge now being levelled against the announcements that were made by my right hon. Friend the Leader of the Opposition on Monday is that they represent at attempt to gerrymander resources. The truth is precisely the opposite. The announcements are a response to the Government's gerrymandering of resources. We seek to set up an established authoritative body that can provide an independent assessment of where health resources ought to go. We want to do that in order to ensure that the national health service is in a position to deliver the objective that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) made clear is shared explicitly right across the House: we want to have a largely tax-funded health care system that is available to people on the basis on need—on the principle of equitable access to those who need it, without regard to ability to pay. Attempts by Labour Members to undermine, or eliminate, that political consensus across the House are doomed to fail. I want to return to some of those themes in a moment.
	I congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on the fact that he has focused the debate on the key resource of the national health service. The message coming back right across the health service is that, although Ministers repeatedly say that the delivery of health care depends on the professionalism and commitment of health service staff, which we all know to be true, the message that is received by national health service staff themselves is that their professionalism and their commitment to the service is being systematically undervalued by the Government who are supposed to be their employer. Staff feel that their commitment is undervalued because—despite the huge increase in resources committed to the health service, which commands support right across the House—they find themselves in the too familiar situation of being caught up in the management of short-term crises that are repeating themselves right through the national health service. In any organisation, when people find themselves responding to firefighting initiatives and short-term crisis management measures, that undermines morale and that is precisely what is happening right through the national health service today.
	Like my right hon. and learned Friend the Member for Rushcliffe, I think that it is fundamental that we understand why that situation has arisen despite the huge increase in resources committed to the national health service. I was struck by the fact that Secretary of State was lecturing the House from the Dispatch Box on the importance of Ministers and managers in the national health service facing hard truths about the requirement to use resources efficiently if the health service is to deliver its objective of equitable access to high quality health care. As my right hon. and learned Friend said, he has made that speech, as have I—every Secretary of State for Health has made it. The problem is that this generation of Ministers had a once-in-a-lifetime opportunity to use resources to address some of those fundamental problems of efficiency in health care delivery in the health service and they fluffed it. They had an opportunity that was not available to my right hon. and learned Friend when he was Secretary of State for Health and that he made certain, when he was Chancellor, was not available to me when I was Secretary of State for Health—an opportunity to use that huge increase in resources to oil the wheels of change. The present Government had the opportunity to use those resources to provide a step change in the efficiency and quality of service that is being delivered by the health service. The present generation of Ministers has missed that opportunity and the result is that we are back with short-term responses and crisis management.
	Let me give the House three specific examples of what that means in practice for people who deliver care to patients on a day-by-day basis, rather than make speeches about the health service. First, we have what are often called in health service-speak the priority services. There is an unintended irony in that phrase. I am talking about community services, therapies and the low-tech services that are delivered at community level that often bring a quite disproportionate benefit to the quality of life of patients. However, they are the easy targets every time a health service manager faces the need to make short-term cuts so that the books can be balanced. That is why we have unemployed physiotherapists throughout the country—the health service cannot afford to employ them—why occupational therapists are looking for jobs and why social services are complaining about their inability to get local partnership arrangements out of the health service.
	The effect of such short-term cuts in community-based services throughout the health service is twofold. First, they undermine morale because those who are delivering the service know that it is not as good as it could be. Secondly, and absurdly, they mean that we are building up long-term costs in the health service because people are being trapped in hospital, rather than released to properly funded and resourced community services.

John Bercow: Of course, that is true of not only doctors and nurses. Is it not particularly absurd that whereas there is a substantial increase in the number of trained and qualified speech and language therapists, there is also a substantial increase in the unmet need among children who require the service, but for whom the employed personnel to provide it do not exist?

Gordon Prentice: That is the argument about NHS Logistics. We can deconstruct organisations such as the police service. One might say that police officers should be fighting crime, not patrolling motorways, so we should take that responsibility away from them. The same could apply to the national health service. There are many people who want to be in the national health service family, and I agree that they should be partof it.

Gordon Prentice: I very much doubt it, because there are no consultation procedures when services are moved from the NHS into the private sector. There was no consultation—it just happened. I got my information from the PCT; I did not have an opportunity to say that I do not want Netcare to be responsibly for urology, gynaecology, and ear, nose and throat procedures.I do not want that South African company to be responsible, but I was not asked, and nor was anyone else.

Gordon Prentice: My friend has abused the generosity that I demonstrated when I allowed him to intervene. There are plenty of opportunities for balanced discussion at the meetings of the parliamentary Labour party. I am trying to save my local accident and emergency department, as the decision will be made tomorrow.
	The overview and scrutiny committee reports to my friend the Secretary of State, who has the power to refer the proposal to the independent reconfiguration panel, which consists of independent clinicians from across the United Kingdom who do not know east Lancashire. If they say that the department has to be closed—I say this to my friend the Member for Wigan (Mr. Turner), who takes great delight in interrupting me all the time—we can live with that, because independent clinicians will have made that recommendation, not the director of accident and emergency services, who will speak at the overview and scrutiny committee minutes before the councillors are invited to make a decision.
	There have been 13 recommendations from overview and scrutiny committees to the Secretary of State but she has passed only two of them on to the independent reconfiguration panel; that is not good enough. I had a meeting yesterday with Dr. Peter Barrett, who chairs the independent reconfiguration panel, and I told him that I hoped that there would be a reference through the overview and scrutiny committee to the Secretary of State, and that she would not throw it in the wastepaper basket, but that she would pass it on to that panel, which we on the Labour Benches set up tomake recommendations that would carry public confidence—in this case in my constituency and the neighbouring constituency of my friend the Member for Burnley.

Michael Mates: It is often what happens to individuals, rather than what happens to institutions, that tells us when something is going badly wrong. Over the past two years, I have read with mounting disbelief letters from my constituents about the NHS in Hampshire. In case after case, they complain that they cannot get the treatment that they need. They tell me that national policies, such as cancer treatment within four weeks of diagnosis or the provision of services in community hospitals, are not being delivered on the ground.
	When I take up these problems with the relevant authorities, I am sent from one to another, on a bewildering journey around an amazing merry-go-round of bureaucracies, none of whom seems to be wholly responsible for what has happened. Is it the hospital trust that is responsible, or the primary care trust, or the National Institute for Health and Clinical Excellence—or even, perhaps, the ambulance service? The space between the various bodies is not so much a gap as a swamp into which my queries sink into boggy depths, with all too often no satisfactory explanation for what has gone wrong.
	Let me say something else—by way of light relief, perhaps. The new Hampshire strategic health authority started on 1 October. Its chief executive was the chief executive of one of the major trusts in the county; he has moved up the ladder, as so often happens in such situations, and I do not knock him for that. However, when I wrote to him about a problem at the beginning of September, he replied—very promptly—that he could not help me until 1 October because he did not exist until then. Such bureaucratic problems make a bad situation even worse.
	Only yesterday, I received a letter from a constituent whose wife was diagnosed with a brain tumour on9 June at Queen Alexandra hospital in Portsmouth, and it is that that has prompted me to take part in a health debate, which I do only very infrequently. Despite continuing pressure from her husband and her GP, no treatment began within the target time of four weeks. Indeed, they had to wait nine weeks for treatment at the other hospital in Portsmouth,St. Mary's. During the intervening period, her condition deteriorated, so that in the end radiotherapy treatment was too much for her to bear and had to be stopped. She died six weeks later.
	Why did she not receive treatment within the stated time? I shall seek an explanation from the two hospitals involved. One of the things that my constituent simply cannot believe is that it takes two weeks for medical records to travel the two miles from one hospital to the other, because they are sent by second-class post.
	But it is not just in headline grabbing areas such as cancer treatment that the NHS has problems. The Government say that they are committed to community hospitals, but both of the community hospitals in my constituency have experienced significant service reductions at a time when, as everybody agrees, the NHS budget has been expanding. At the Alton community hospital, the Inwood ward was closed for many months. Happily, it will now reopen. At Petersfield hospital, the Grange maternity suite was closed at two weeks' notice because of staff shortages, and it has stayed closed for 16 months. Happily, that is also now reopening. But how could the planning go so awry that those closures were necessary in the first place?
	The trouble is that the NHS—particularly in Hampshire—is suffering from a stop-go policy. Sudden staff shortages or budget crises cause the withdrawal of a service. That sets off an understandable public row. Health service managers promise to reopen the facility, but are vague about when that will happen. After many months—often over a year—it is necessary to launch a recruitment drive to find the staff to run the service so that it can be reopened. Meanwhile, other parts of the NHS are making people redundant. The facility then reopens, but often—as at Petersfield—with a reduction in services.
	That stop-go approach is deeply debilitating. It undermines morale in the NHS, wastes resources as facilities have to be closed and then reopened, and, worst of all, it bewilders patients. It is the most vulnerable patients who suffer from the closure of community hospital facilities, as they are the ones who are unable to travel to the nearest district general hospital.
	This mismanagement—that is what it is—results from the total absence of stability within the service, as my right hon. and hon. Friends, whose knowledge is greater than mine, have mentioned. When my right hon. Friend the Leader of the Opposition spoke about taking politicians out of the NHS, he did not mean for us to walk away from our ultimate responsibility to provide health care; he meant that the constant chopping and changing brought about by the pressure of party politics has to stop.
	Somebody said that there have been seven reorganisations of NHS bureaucracy since 1997, but I make it 10. I am not trying to dismiss the value of managers—good managers save lives by making the best use of inevitably limited resources—but it is no good Ministers trying to pretend that constant changes in management and structures do not adversely affect patients, because they do. An estimated £320 million is being spent on the current reorganisation of PCTs, and many of my constituents want to know why that money is not being spent on patient care.
	Another constituent of mine has kidney cancer, and his consultant at Southampton general hospital wants to treat him with a new drug called Sunitinib. Clinical trials of the drug have been conducted for about six months and it has proved extraordinarily effective, to the extent that another of my constituents—a 38-year-old woman—is back home with her family. Yet before the trials began, it was thought that she had only weeks to live.
	My constituent's kidney cancer was diagnosed two days after the trials officially ended, and although the treatment has been proven to be highly effective, it is not available any more, the argument being that it has not been approved by NICE. Indeed, according to a written answer in June from the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), the Department of Health is still deciding whether to refer the drug to NICE for consideration. When I asked about this, Lord Warner replied that it was for hospitals and PCTs to decide whether to prescribe new treatments. He went further, saying that
	"PCTs cannot refuse to fund drugs simply because NICE guidance is not available".
	He added that PCTs
	"should not refuse to fund treatment solely on the grounds of cost but should consider all the circumstances before making a decision."
	So what is the problem? The drug is the treatment of choice of the consultant, who is thrilled with the success of the trials. It is available, but it is not allowed to be prescribed and my constituent cannot have it.
	The reality is that health rationing is going on all over Britain, and it is a complete lottery as to whether a particular treatment is available in a particular area. That does not add up to a national health service. I do not doubt the personal commitment of Ministers to solving some of the problems, but they do not seem to recognise that it is their making constant changes,the expansion in the number of managers and the obsession with targets that is denying patients the choice that they should properly have. If the focus of the national health service should be on anything, it should be on nothing more than patient care.

Ian Austin: The hon. Gentleman can listen for a while. Let him listen to what the Leader of the Opposition said about the proceeds of growth rule this year—his words, not mine. He said:
	"As that money comes in let's share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government."
	He also said that he wants to replace public services for the poor with
	"a profound increase in voluntary and community support".
	It is the same old Conservative ideology: a small state and spending cuts, leaving the most vulnerable relying on charity. That is why the Tories cannot promise that they will not cut funding for the NHS.
	Before the Leader of the Opposition's conference speech last week, the Conservative party website said that it would promise:
	"We will never jeopardise the NHS by cutting its funding."
	That line also appeared in the extracts released to the media before the right hon. Gentleman delivered the speech, but it did not appear in the final version orthe published version.
	The Tory motion claims that the NHS is being cut, but the Opposition voted against the extra funds we invested. In fact, not only did the right hon. Gentleman oppose the national insurance increase at the time, he called for a social insurance system for health care instead. The Tories cannot say that they have changed that position, because only this week the shadow Secretary of State repeated his opposition to the tax increases that paid for the improvements. Time and again, they use moderate, compassionate language to mask traditional Tory positions.
	Today's Tories claim to support the NHS, yet they run it down at every opportunity. They tell us that they believe in the health service, yet they are still committed to massive cuts. They say the NHS is underfunded, yet they vote against extra spending. It is absolutely clear that when it comes to the health service—just like everything else—they do not have even one centre-ground policy.
	There is no huge secret about the so-called new Conservative party. Every speech makes it absolutely clear: the Tories may not spell out the lower taxes they want, or the precise parts of the so-called "big state" they want to cut down to size, but anyone who looks beyond the rebranding will see the same old Tories committed to the same old spending cuts. Instead of greeting their so-called changes with warm words of approval, we should expose the fact that they are not really changing anything at all. We should demonstrate that they will claim anything to win, but that they do not believe a word of it.

Nicholas Soames: First, I congratulate NHS staff in my constituency on delivering a wonderful service in a very good hospital. They are presently very nervous and anxious about the future. I also warmly congratulate the shadow Secretary of State on the excellent way in which he moved the motion. I hope that the House listened carefully to the speeches of the two former Secretaries of State for Health, my right hon. Friend the Members for Charnwood (Mr. Dorrell) and my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), which were full of wisdom and clarity about the way ahead. I wholly agree with the picture painted by my right hon. and learned Friend the Member for Rushcliffe, who took a tremendously national view of the NHS, to which I wholly and unreservedly subscribe.
	In 23 years as an MP, I have never known such anger and anxiety directed at the Government as is now being generated on national health issues. Since I became the Member for Mid-Sussex in 1997, there have been four reviews of hospital services—nothing like as many as experienced by my right hon. Friend the Member for East Hampshire (Mr. Mates)—in my constituency and local area. We have had "Modern Hospital Services for Central Sussex—A challenge for us all" in 2000, and even more ridiculous names such as "Strengthening Hospital Services in Central Sussex" in 2001 and the "Best Care, Best Place" consultation in 2004. Now,18 months on, we have a new document that sweeps all the rest into the waste paper basket: "Creating an NHS Fit for the Future".
	Those reports were all subsequent to a document commissioned by the West Sussex health authority, which was faced in 2000 with growing fragmentation in health care provision, escalating and disproportionate management costs and rapidly accumulating debts, which are at the nub of our present unhappy state. Matters were so serious that the Government asked Michael Taylor, then chief executive of Oxfordshire health authority, to investigate and report on West Sussex as a failing and debt-ridden health authority. His report, which was damning, set out a series of recommendations, which were by and large completely ignored by Candy Morris, who was acting chief executive of West Sussex health authority until its demise. She was also responsible for the NHS consultation documents from 2000. By an astonishing quirk of fate, she is now one of the architects of proposals about to be announced for the apparent deconstruction of the NHS in West Sussex.
	Those changes will throw the NHS in Sussex into even greater turmoil than is already the case. What Taylor exposed was a series of top-heavy management structures, in expensive premises—the sort of point made by my right hon. Friend the Member for East Hampshire—involving duplication, replication and wastefulness. No one paid any attention to his warnings and this continuing, wilful mismanagement of the NHS has now led to colossal debts of well over £100 million in West Sussex.
	Another important contributory factor in this debacle has been the complete failure of the independent watchdog bodies—first, the community health councils and latterly the West Sussex health scrutiny committee and joint scrutiny committee—to refer any of the proposed configurations to the Secretary of State for intervention and for her to account to Parliament directly on that managerial vandalism.
	What the Secretary of State must understand is that when the "Best Care, Best Place" consultation began in November 2004—incidentally, it was a total sham, in which, again, the scrutiny committee failed to act—it was represented to all my constituents and me by the management of the strategic health authority, and most especially by the primary care trust, as the way ahead for the foreseeable future. Many of them were deeply cynical of the Government's motive at the time, but they went along with it.
	As recently as 25 May, at a meeting that I called in Burgess Hill in my constituency, the chief executive of the South East Coast strategic health authority—a newly created animal—never mentioned any of the changes that were likely to happen, even though they were being discussed at board level and elsewhere. My constituents and I feel that that amounts to a deceit, a betrayal and totally unacceptable behaviour by the management of the NHS, which has lost its way and has been party to the waste of hundreds of millions of pounds over recent years—money that could quite well have been spent on patient care.
	I have referred that catalogue of incompetence and bad practice to the Comptroller and Auditor General, who, alas, cannot take it any further, but he has referred me to his excellent report on financial failings in the NHS. What I hope that the Secretary of State will understand is that we in Sussex think that her Department seems rather like the American Administration: apparently, at the same time, dysfunctional and fragile and unable to admit or unwilling ever to see—let alone to correct—the obvious mistakes that are being made in their name.
	The constant reorganisations of the past few years may create for the Government an illusion of progress and reform, but in practice what has often happened in the recent past is that it has produced confusion, uncertainty, gross inefficiency, very serious staff demoralisation in excellent hospitals and, above all, a lack of a coherent sense of direction by managers.
	Our area is expected to accommodate 41,000 new houses in the next 20 years; our local infrastructure is woeful. I have drawn to the House's attention on many occasions the infrastructure deficit in my constituency, yet with all the added pressure for existing and future growth it is clear that the PCT plans to downgrade the Princess Royal hospital by removing the accident and emergency department altogether, although I was assured by a Minister at the Department of Health on the Floor of the House a year ago that there was no question of that happening. Indeed, the "Best Care, Best Place" consultation document said that both the Royal Sussex County and the Princess Royal hospitals will keep their A and E departments. Those assurances turn out not to be worth the paper that they were written on.
	Brighton, where the A and E department is to be removed in totality, is hopelessly inaccessible by road. Its hospitals simply cannot cope with the load that is being placed on them, with patients constantly being referred back to the Princess Royal hospital. Gatwick airport is only 15 miles away, and there is always the possibility of a major catastrophe. In times of conflict, the Princess Royal hospital would be needed as a casualty clearing station. There is a major and very busy motorway on the doorstep, combined with very high housing and population growth.
	This weekend, I hope that thousands of people will march in Haywards Heath in an all-party campaign to support the Princess Royal, to draw the attention of Ministers to the fact that we cannot allow our services to be downgraded because that is not safe and to complain about the instability of the service provided to local people. Although I agree with my right hon. and learned Friend the Member for Rushcliffe that there have been many changes for the better and that excellent changes are afoot to move services into the local community, interfering with the fundamental infrastructure of the health service in the way that is being done is a fatal mistake.

Bob Blizzard: One of our greatest human failings is our lack of memory. I fear that today and in the weeks ahead the Conservatives will try to play on that by hoping that people will forget what the national health service was like in 1997. I would like to remind the House what it was like in my area. Like everywhere else, we had long waits for elective treatment—18 months was the norm and, as we have heard, it could have been anything up to two years. The biggest change in the health service over the past 10 years is shown by the fact that nobody in my constituency now waits more than six months.
	Going to accident and emergency in 1997 was really unpleasant. One could expect a long wait in crowded conditions in an environment that was miserable rather than comfortable. The second biggest change that we have seen is that today one can go to a completely modernised accident and emergency unit that is not crowded and one can be treated in under four hours. My hospital achieves that for 98 per cent. of patients.
	They were chaotic times back then. The first national trust to go out of business was in my area. The Anglian Harbours NHS Trust, a community services trust, did not just have a deficit, but crashed and went out of business. Local NHS managers had to pick up the mess. Lowestoft community hospital was threatened with closure and, yes, we marched up and down the streets to save it, and we managed to under this Labour Government.
	Mental health care was a complete failure in my area, with appalling Victorian and inconvenient in-patient facilities. Community mental health services were thin on the ground so that when I and my hon. Friend the Member for Great Yarmouth (Mr. Wright) were elected, we decided to march off to the Secretary of State to get something done. Thankfully, the regional health authority accepted our case and put matters right.

Graham Stuart: Will the hon. Gentleman turn his mind to looking ahead? As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) said, if we looked back, we would see significant improvements in any 10-year period such as the 81 new hospitals that were built under the last Conservative Government. Will the hon. Gentleman follow the example of the hon. Member for Pendle (Mr. Prentice) who looked at the difficulties, which does not mean denying that improvements and benefits can be found? Looking at the problems and concerns today about the failure of productivity would help us to get a better deal for patients. After the hon. Member for Dudley, North (Mr. Austin), we have yet another party political rant based on the memories of what happened 10 years ago, and that is an entire waste of time. The hon. Member for Waveney (Mr. Blizzard) should focus on tomorrow and the issues that we face today and try to make a difference to not just his party.

Bob Blizzard: If we want to understand the future, we have to understand the past.
	We thought of going to the then Secretary of State, my right hon. Friend the Member for Holborn andSt. Pancras (Frank Dobson), because he had already intervened in the East Anglian Ambulance NHS Trust, which habitually failed to achieve its target response times. That trust delivered last year the fastest response times in the history of East Anglia.
	All the trusts at that time found difficulty recruiting staff because pay was low and the NHS was just not attractive. That was the dismal picture of the Tory NHS that we endured for 18 years. We had reorganisations too and I will declare an interest: my wife works for the health service and she was reorganised and reorganised again. Sadly, she has been reorganised a few more times since this Government came to power, but one of the worst things the previous Government did was split the Great Yarmouth and Waveney district health authority and the natural health economy that shares the same hospital. I am delighted that the Secretary of State put that back together again in the recent PCT reconfiguration.
	The transformation today is so great that if I had promised what we have today in 1997, I probably would not have been believed. The cornerstone of our local health service is our general hospital, the James Paget. So much investment has taken place in the hospital that I have no time to list it all. We have had our share of the extra doctors and nurses, a new accident and emergency unit, as I have said, new theatres, intensive care units, maternity units, pathology facilities, eye units, new renal stations, scanners, digital X-ray, and most recently a new emergency admissions and discharge unit, which is helping to make the hospital far more efficient and to treat more people.

Bob Blizzard: If the rumours are being spreadby Conservative Members, they will be very disappointed—

Bob Blizzard: No; I have given way twice. I am absolutely confident that our hospital will remain a first-class district general, and I will not accept scare stories spread in this House.
	The hospital is high quality because it has met every target set for it ahead of time: 100 per cent. of people do not wait six months or more; 100 per cent. of cancer patients are seen in two weeks; 100 per cent. of those diagnosed with cancer are treated in one month; and98 per cent. of people who turn up at A and E are seen in under four hours. My local hospital has got to grips with MRSA: last year it saw 300,000 patients and had 41 cases. It has had only 14 cases in the past seven months, but it wants to do better. Even its food was given a 98 per cent. satisfaction rate among patients in a recent national survey. That is why the hospital has been a three-star trust for successive years, why it has had no deficit for 2005-06—in fact it had a surplus—and why in August this year it became a foundation trust hospital, joining the other 47 in the country.
	I have been calling it the James Paget hospital, but its new name is the James Paget University hospital, because it is now part of the new medical school that was established at the university of East Anglia, which has done so much for the health service in our area, bringing new, young medics whom we can recruit when they qualify.
	This year will be a challenge for the hospital, but it is having to make no redundancies and I am increasingly hopeful that all the trainee nurses will get jobs. In another recent national survey, on staff satisfaction, the hospital came 10th among 200 surveyed.
	That is a great performance and it has been aided by innovation. I told the House last year about the work of orthopaedic surgeon Mr. John Petri, who carries out dual operating and so has no waiting list. He moves between two theatres and two teams. If hon. Members want to do something for their local health service today, they should ask their hospitals why their orthopaedic surgeons are not carrying out dual operating and getting waiting lists down.
	The future is bright for my local district hospital. As a foundation trust and a self-governing hospital, it has £40 million to invest over the next five years on ward upgrades, to enable it to exercise even better infection control, and on upgrades of patient facilities too. Its aim is to be a full district general hospital of high quality. That is what local people want and I am confident that that is what it will remain.

Bob Blizzard: No. I have taken two interventions and I get no more extra time.
	The purpose of my telling the House about the hospital is that the James Paget hospital shows that a well run NHS hospital can operate within the finances available to it, meet all its targets and deliver quality services without any deficits.
	I do not have time to go into so much detail on primary care and community services, but suffice it to say that Waveney primary care trust set out its own "care closer to home" approach before the Government paper, so we see an important role for our community hospitals. The Lowestoft hospital, which faced closure, has had a major overhaul with massive investment,and I welcome the Government's announcement of £700 million more across the country and hope that some of it will come our way.
	Many of my constituents in the western part of the area are served by All Hallows hospital. It belongs to a charitable trust and has provided services for many years for elderly NHS patients in my constituency and in south Norfolk. A problem arises, however, when two neighbouring trusts do not move in the same direction, and we have such a problem at the moment with South Norfolk PCT, which is talking about reducing the number of contracts. If it does that, there will be a knock-on effect in my constituency, where the local trust wants to go in another direction, so I hope that we will see greater co-ordination. With practice-based commissioning, I know that local people will want to choose that hospital and that GPs will want to send them there, so with that type of commissioning and the new payments system, we hope we have a future.
	As I said, the best thing to happen to primary care in my constituency was the formation again in the recent reconfiguration of a Great Yarmouth and Waveney PCT. That organisation can focus on commissioning the health services that are right for our local area based on local need, working closely with local GPs to serve local people, maintaining that relationship with the local hospital, and getting the funding appropriate to our needs. In mental health, we have brand-new facilities for in-patients. The ambulance service has turned itself around completely, as I said, and I expect it to get a good rating from the Healthcare Commission tomorrow.
	What has made the difference since 1997? Obviously, the increased funding, which the Conservatives opposed, has made a great deal of difference, but the other element that has made a difference is targets. The Opposition criticise targets, but if life was so good without targets, why was the NHS such a mess in 1997? I admire medical professionals; I work closely with them and I know that they are dedicated, but they need co-ordination and direction. I do not think that we can simply leave them alone to get on with it.
	That raises the question: what is the role of politicians in the NHS? I attended a meeting in Manchester where a gentleman from the British Medical Association kept referring to politicians "meddling" in the NHS. Well, my constituents expect me to meddle in the NHS—they elected me to meddle in the NHS. Every month some of them write to me asking me to meddle in the NHS, and the people who ask me to meddle the most are BMA members—local doctors. They ask me to lobby Ministers to get things done, and sometimes—quite regularly, in fact—it works. If politicians do not involve themselves in that way, people will ask what is the point of voting for them and turnout will fall even lower.
	I do not want to hand over the NHS to an independent board. I do not believe that it would be independent or be seen to be independent. Politicians would still get the blame for things that go wrong, but they would have no power to deal with them. I wonder what an independent board would become under the Conservatives. I worry that it would float away in the direction of charges, self-pay, patients' passports, vouchers and all the other principles that we have often heard stated by Conservative Members.
	I think that the NHS is safest in politicians' hands because the British people, who cherish the NHS, will punish those politicians who do not look after it, as they did the Conservatives in 1997. Politicians know that. That is why we are committed to the NHS and why the Conservatives just pretend to be. The Conservatives and their newspapers are trying to present a picture of an NHS that is falling apart, but the NHS Confederation has just published a report, "Lost in translation", which points out that when people who have been in hospital are asked about the experience, they say that they had good treatment. Some of them think they were lucky, but they were not lucky; they just voted Labour three times and they now have a Labour NHS.

John Pugh: I shall be brief, because much of my thunder has been stolen by the hon. Member for Pendle (Mr. Prentice). I could not better his critique of what is going wrong in the health service.
	The main focus of the debate is on NHS planning, or the lack of it. NHS planning is in danger of becoming an oxymoron, like "journalistic balance". Although it is not my habit, I can best illustrate that point using events in my constituency, where we have the usual litany of modern NHS ills, especially in the acute sector. Only this week, we had another ward closure; this summer, we had ward closures, cutbacks and redundancies, not only among support staff, but on the clinical side. All year there has been anxiety about deficits and disputes about their cause and the solution to them. We have seen plenty of management consultants, plenty of hassle and plenty of controversy. Despite all that controversy and hassle, the staff have got on and delivered an exemplary service, but the word "planning" has no place in their world that they can understand. One can plan only when one properly understands the environment in which one is working, and there is no evidence over the past 10 years in my constituency that anybody has been able to do that.
	Ten years ago my local trust, which controls two hospitals, tried to deliver a plan—not a very good plan, but it was based on allegedly clinical criteria. It was based on the demands of the medical profession for safety, clinical standards, training capacity and so on. It was deeply flawed. It had children who had suffered any kind of trauma or accident by-passing a fully fledged casualty department, and it was not acceptable to the people of my constituency. It was supposedly and unconvincingly based on the latest recommendations from the royal colleges, but it was at least coupled with a substantial new build investment programme.
	However, even before the quoted medical advice had changed and before the plans were allowed to settle down, they were all thrown into the melting pot by the unexpected implications of junior doctors' hours and changed conditions and the European working time directive, none of which hospital managers could do a great deal about. Just as that was heading for a settled outcome, payment by results appeared on the radar, ushering in uncertainty and further turmoil. Management consultants then proposed clinically absurd proposals at variance with all the previous proposals, and the new capital investment under payment by results became a financial millstone. The accountants—McKinsey's, Ernst and Young and the rest—rather than the doctors appeared to be callingthe shots.
	That was not planning. It was reactive. It was crisis management. It is crisis management, but each crisis is internally generated. The public are left baffled and angry and the politics is messy and at times unpleasant. At the height of all this, there was a blessed moment of sanity in my constituency. The primary care trust, backed by the strategic health authority, took matters in hand, called all the parties together, sat them down and asked simply, "What do people here need? What can people fairly expect to receive?" Genuine consultation took place and for a time real solutions seemed to be in the offing. It was a model of crisis resolution.
	Clinical networks were planned, sensible co-operation between all parts of the local NHS was envisaged, including specialist hospitals such as Alder Hey, and a genuinely workable road map was worked out, but then it all got parked. The PCT was abolished, the strategic health authority was abolished, the plans were sidelined, clinical networks were dropped and people were moved on. New financial goals were set overnight, management consultants from outside came in again, politics intruded again and the local NHS was turned upside down again. Financial considerations seemed to dominate over clinical delivery.
	Like most trusts in the NHS Confederation, my trust is reciting the current mantra that so many beds and so many nursing staff may not be necessary. People cite figures showing the considerable fall in hospital occupancy over the past decade. However, they omit to tell us that the number of acute beds, as opposed to beds for maternity and the elderly infirm, has not fallen appreciably. We get flimsy clinical excuses for financially based decisions. Looking on anxiously in almost every constituency are the poor public—the citizen, whether ill or well—unable to detect the shape of future services, unsure of what awaits them, and unconvinced of the existence of even a Baldrick-like cunning plan.
	As I look back over the past decade, I can detect periods when the concerns of doctors were dominant, periods when the interests of hospital administrators were dominant, and times such as the present when the voice of the accountant and the management consultant is dominant, but I have yet to experience a period in which the voice of the community and the patient is dominant, and I have yet to see an argument against it.

Patrick Hall: When I was first elected to represent Bedford and Kempston in 1997, a regular feature of my postbag then and for some years thereafter was people asking for help because of the consequences of excessive hospital waiting—the pain, the living in distress and the time off work. Many people were driven to the private sector. If that goes too far, it undermines the principles of the NHS. That is the way it was nine years ago. Today, I hardly ever have such a case brought to me by a constituent. People acknowledge that there has been a real improvement in waiting times. The Conservative party must hope for a national collective outbreak of amnesia on this point if it is to make progress with its claim to be the true party of the NHS.
	The Government have even more ambitions than their achievement so far. The plan is that, by the end of 2008, the overall maximum wait in the NHS will be18 weeks. That is from GP to operation, including diagnostics, and that has never been attempted before. In practice, for many interventions, that will mean an in-patient treatment wait of seven or eight weeks, which will truly revolutionise the NHS.

Patrick Hall: I did not follow that entirely, but yes, of course, we want a better NHS, if that is what the hon. Gentleman said. If we have more services in the community, that will free up the acute sector to enable it to treat more people more quickly. If people have to go to hospital, they want the prospect of safe treatment without having to wait too long and as locally as possible, although that depends on the nature of the operation that they face.
	Not enough has been said about the plans to modernise the NHS. It has not been sufficiently reported. It involves change and change can be difficult, but it is a good news story which, when I discuss it with NHS staff and constituents, is one that they can broadly sign up to, even if it goes under the peculiar term of reconfiguration.
	But the context has dramatically changed in recent months, and that context arises from the consequences in Bedford of the Bedford Hospital NHS Trust's£11.8 million deficit. I do not have time to go into why there is that deficit, but it is combined with the Government's decision this year to address the NHS's overall deficit of the last financial year by top-slicing the budgets to PCTs, and the two together have created real pressures. They are short-term financial pressures, but they could lead to up to 200 redundancies at Bedford hospital, although the figure is likely to be significantly less. Nevertheless, it is worrying, and damaging to staff morale, and it will slow up the development of the consequential primary care services that will be needed if there is to be a shift to some extent from acute to primary. Such uncertainty is bad for staff morale and the public do not understand what is happening. They know that there have been improvements and that there is a lot more money year in, year out, but they face difficulties such as they have not experienced for years. That situation provides fertile ground for others to increase people's fears by telling scare stories. In the case of Bedford hospital, the scare stories were started by the Liberal Democrats in  The Daily Telegraph on 14 September. The scare tactic involved saying that Bedford hospital is scheduled for closure—a Bedford hospital consultant went on the record to make that point and Bedford and Kempston Conservative party is circulating a leaflet reinforcing the fear of the threat of closure. Let me make my position clear. I totally support Bedford district general hospital as a viable district general hospital. The hospital is not at risk from closure, and it is wholly wrong to whip up fears that it is.
	The important issues are more difficult. The serious issues facing Bedford district general hospital are managing the four-year financial recovery plan to eliminate the hospital's debt, changing the shape of local NHS services to improve them for the long term and ensuring that those two tasks are carried out while maintaining a full range of services, particularly the 24-hour accident and emergency service. Those are the challenges in Bedford, and they clearly worry my constituents. We are not helped by fears being whipped up unnecessarily, which goes on day in, day out in my constituency.
	There are real problems that we must face up to, so what should we do? First, when changes are prepared and published, there should be a three-month statutory consultation process with which people are urged by all parties to engage on the basis of facts and a measured and informed debate rather than on the basis of scare tactics.
	Secondly, the Government must examine RAB, the resource accounting and budgeting financial management system that now applies across central Government. The principles of RAB have supposedly been applied to NHS trusts across the country, which means that, if a trust reports a deficit in one year, its income is reduced by that amount in the following year. That is a double whammy, which is unfair and guaranteed to make a difficult situation worse. Furthermore, the in-year deficit is reported to the balance sheet reserve and carried forward cumulatively. Bedford hospital trust reported an income and expenditure deficit of £8.48 million in 2004-05, and Bedford PCT passed on a reduction in its service level agreement income of that amount in the following year as a result of RAB. However, because that reduction would have devastated the hospital, which would not have been able to pay many of its staff, the trust was permitted to borrow that sum from the strategic health authority. That cash borrowing, which did not appear in the accounts in the normal way, was interest-free, and the sum was to be paid back in the following year. In 2005-06, the in-year deficit was reduced by the trust to £3.41 million, which under RAB should have led to a cut in its income of that same amount in this financial year, but that did not happen, because a deal was done with the SHA.
	I hope that Ministers look carefully at the Audit Commission's review of the NHS financial management and accounting regime, which contains a clear and powerful critique of RAB and the labyrinthine system of complex financial devices which dominates, and has always dominated, the NHS. It calls for an end to RAB being applied to the NHS and for a system of much greater clarity and transparency. What is happening to Bedford hospital reinforces the message from the Audit Commission. In one year, RAB was applied, but cash borrowing was allowed to cover the cut, and then it was not applied in the next year.
	Some might say that we muddled through and that the situation is okay, but I disagree, because the system is bizarre and confusing, and it perpetuates a culture within the NHS that is not businesslike. If RAB were not applied to the NHS, as proposed by the Audit Commission, which has also made suggestions for improvements, Bedford hospital and other trusts with deficits would still have to address their deficits. We are not talking about just wiping deficits clean and pretending that they do not exist, but at least we could then build on a system that enables clear planning, openness and transparency which more people than just the finance director could understand. The NHS needs that important development, so that it is not just left to the finance director to understand the finances, and so that all elements of a hospital, for example, contribute to financial efficiency.
	It is also important to get rid of RAB so that we abolish its cumulative balance sheet feature. That element might not appear to matter, but it will from April next year when the capital funding regime is due to change and an NHS trust's ability to borrow will partly be judged by the state of the balance sheet. Under RAB, while Bedford Hospital NHS Trust should eliminate its deficit within four years, the balance sheet will show the deficit for eight years. That is a wholly ridiculous situation.
	Thirdly, we should continue to close the gap between what the health economy in Bedfordshire gets and what it should get in terms of its capitation—the system known as fair funding. Year on year, in Bedfordshire, despite Conservative claims that somehow money is being robbed from Bedfordshire in order to over-fund the north of England, this Labour Government are closing the gap with regard to fair funding. We need, however, to continue that process.
	Fourthly, we need a period of stability within the NHS—

Simon Burns: I listened carefully to the speech by the Secretary of State for Health. The sheer horror of the situation suddenly came to me when I realised that either she is living in cloud cuckoo land or she is in a total state of denial about what is going on in the real world beyond this Chamber. Like all Members, the Secretary of State has constituents and, I presume, receives correspondence every day from them and the wider public because of her public role. I am amazed that she seems to think that everything is going well in the NHS and that there are no problems.
	Equally, it is fatuous for hon. Members, Ministers and others simply to refuse to accept that the previous Government did good things in the health service. Since 1997, this Government have also done good things for the health service. As my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) rightly said, there is a growing consensus in this Chamber and the country over the national health service—a consensus to which I have adhered from the first day that I entered this House—that we should have a first-class health service, based on free access for those eligible to use it and paid for by taxes, except for those areas on the fringes that, historically, have not been free at the point of use, such as prescription charges.
	If we work from that basis, we have a golden opportunity—especially given the revenue that the Treasury has been able to glean in the past 10 years because of the economic situation that resulted from the difficult task on which my right hon. and learned Friend embarked on in the mid-1990s and the record amounts of money that the Government have put in, which it would be foolish not to acknowledge—to introduce fundamental reforms to ensure that we get value for money from our investment and that patient care improves. There have been improvements in the health service in the past 10 years, but there are also some significant problems. Because of the lack of structural reforms to improve productivity, we have returned to short-term thinking to try to address the emerging problems.
	My constituency has a fantastic local hospital in Broomfield hospital, which has an excellent management team and a first-class, hard-working and dedicated staff. I pay tribute to them, but there are problems because the money that has been made available in record amounts by the Government is not reaching front-line services at the level and in the scope that we would expect. Chelmsford PCT has a deficit of £13 million. To try to overcome that problem, as it has been told to do, two intermediate care wards have been closed completely, so there is now a gap in intermediate care that will have a knock-on effect on the local hospital and, potentially, delayed discharges will begin to escalate again.
	We also have a problem with the hospital trust. Some 200 jobs will be lost or not replaced to meet its financial deficit. We also have a nurse training school at the Anglia Ruskin university. Four or five years ago, the Department of Health was trawling the third world for nurses to work in our health service because it was short of nurses. More and more people were encouraged to train as nurses and investment was made in their training, but now that they have those nursing skills there are very few jobs for them. That is a terrible waste of investment, their talents and their potential contribution to improving and enhancing the national health service.
	I wish to raise another issue that illustrates the problems of the NHS. Before the last general election, the Mid Essex Hospital Services NHS Trust came up with a brilliant PFI scheme worth £180 million. Chelmsford has two hospitals—Broomfield hospital, which is an old tuberculosis hospital that has been modernised and is now state of the art, and St. John's hospital, which was built in Victorian times and is way past its sell-by date. Contrary to what the Secretary of State said—it did not fit her agenda—there are Conservative Members who support hospital closures when they see the logic behind them. From the outset, I have supported the closure of St. John's hospital, as have the medical staff and my constituents, because the services were to be moved four miles to the Broomfield hospital site. That is the right thing to do when the building is outdated.
	The PFI scheme was put together and I fully supported it. It was the centrepiece of the West Chelmsford Labour party's election campaign in 2005—the Government's investment in the health service. I have to hand it to them, because it is a centrepiece that would deliver an improvement in health care. The scheme was ready, it had been validated and approved by the Essex strategic health authority, and it went to the Department of Health in October for final approval. Unfortunately, the Department could not get its act together and, having said that we would have a decision by the end of November and then by the end of the year, it had still failed to make a decision by late January. At that point, the Chancellor stepped in and said that all PFI schemes had to be revalidated, so we were back to square one.
	I raised the issue with the Prime Minister in May. I gave him advance warning and, to be fair, he gave an excellent answer, including the hope that
	"it will have an optimistic conclusion."
	He said that he would look into it and that he could give me
	"an assurance that it will go ahead as quickly as possible, once the remaining issues have been sorted out."—[ Official Report,10 May 2006; Vol. 446, c. 310.]
	I was grateful to the Prime Minister for that response, but it is now 11 October, and the plan has not received the go-ahead. It has also been scaled down, to a probable value of £80 million. If it finally receives approval, the hospital will have 200 fewer beds than it has now, and the outcome will not be the tremendous, state-of-the-art improvement originally envisaged.
	I wrote to the Minister a month ago, and he kindly replied to me today. The trouble is, his letter says nothing in response to my real questions. If the plan fails and does not get approved, the Prime Minister will look foolish. If that happens, I will feel a bit sorry for the people who briefed him when he gave me the assurances and commitments in May. However, there will also be the knock-on effect that a significant amount of money will have to be repaid if the project falls apart and is abandoned. That money could have been invested in health care and front-line services and used to wipe out the deficits of the Chelmsford PCT and the Mid-Essex hospital trust. I think that the East of England SHA is the cause of the problem. Going to see the people there would be a waste of time, as they would tell me nothing new. The Minister must look into the matter and try and get everyone working together, as quickly as possible.
	In conclusion, it would be stupid to suggest that everything is wrong with the NHS at present. It would be equally stupid, however, to suggest that everything before 1997 was appalling. One should give credit where it is due, but Ministers and the Secretary of State must stop patronising the House. The right hon. Lady speaks to hon. Members like a know-all head teacher speaking to naughty schoolchildren. She must accept that there are significant problems with health care delivery in parts of the country, and in certain areas of medicine.
	Those problems have to be addressed. I applaud the record amounts of money that the Government have made available, but that money must be channelled towards front-line service and the provision of even better health care. It must not be wasted on bureaucracy and ceaseless reform. We need stability, so that the NHS can get on with providing the finest possible care for all our constituents.

Andrew Gwynne: I welcome this debate, and am very pleased to be able to contribute to it. I should like to speak about the demands that the NHS faces, and to which it must respond. Demand for a mass health system is not always visible. I have many constituents in parts of Denton and Reddish who need NHS support but who do not actively seek it.
	I think that that is the challenge. Of course, the NHS must respond to the demands made on it, but it must also find new ways for those demands to be made, and especially by the most dislocated and vulnerable people in Britain. The debate has moved on from being simply about quantities of investment. Stephen Watkins, the director of public health in Stockport, has written:
	"For several years now the Government has been investing very large sums of new money into the NHS. This money far exceeds anything that would have been dreamed of throughout the late 1970s, 1980s, or early 1990s. Those who called for UK health spending to be increased to the European average were dismissed as unrealistic dreamers. In 1996, the BMA said that£6 billion of real new investment was required for the NHS and was attacked by other health organisations for going over the top. In 1999, the Government injected £12 billion of real new recurrent money to start a process of increasing NHS spending to the European average."
	He continued:
	"With this additional money the NHS has dramatically improved."
	That is not a political statement. That comes directly from the director of public health in Stockport and his 2006 public health annual report. Clearly, the level of Government spending was the argument in the 1990s. To solve the problems that the NHS may face in the future requires reform for our changing society.
	The Labour Government who took office in 1945 were a response to the demands of post-war Britain. War and sacrifice, both at home and abroad, led to the most demanding British electorate since the emergence of mass suffrage. That electorate demanded that the Government provide a free and first class health service for all throughout the country, and the Labour Government responded. The British people have, of course, changed a great deal since the 1940s. They have become ever-more demanding—my constituents included. Their expectations are much higher and rightly so.
	As we look to the future, this will become an increasingly ageing society. The number of people aged 85 and over has grown to a record 1.2 million. That is resulting in ever-increasing demands on the NHS, but also in many more hidden and vulnerable people—sometimes without family support—with whom the NHS must make meaningful contact. As in the past, the national health service must be reformed and expanded to cope with the changes. By 2025, the number of people aged over 85 will have increased by two thirds. Each of those people will need, on average, five times as much care as the average 16 to 44-year-old. An NHS that can cope with those pressures requires both investment and reform. In fact, the NHS's ability to be reformed and to meet the challenges of the day is why it remains one of the most popular institutions in Britain.
	During the 1980s and the early 1990s, NHS staff were let down by the Government. During the 1980s, the Conservatives managed to build just one new NHS hospital in Britain. Since Labour came to power in 1997, we have turned that decline around. By 2008, more than £90 billion will be invested in the NHS, in a huge range of services. As a result, the NHS is treating more people and treating them faster than ever before, with treatment free at the point of need and availableto all.

Andrew Gwynne: No, I will not.
	Stepping Hill hospital is being rebuilt and Tameside general hospital has been approved for a massive£80 million private finance initiative investment programme. That will include the building of a new state-of-the-art health facility, including an expanded and improved accident and emergency department. The improvements being made to the NHS are, however, not simply a result of investment, but of careful reform. The Conservative party did not want careful reform. Just over a year ago, the Tories believed that the best way to help the people of Britain would be allow the wealthy to pocket NHS money, provided by hard-working families all over Britain, and take it away to subsidise private treatment. That would have left areas in which people have relatively poor health and low incomes, such as parts of my constituency, starved of much-needed funds. The Tories are still at it. Having voted against the extra investment in the NHS, they now want that money to be spent only in their areas, where deficits have accrued. They cannot campaign for more money in public while voting against it in the House of Commons.
	Our challenge is to find the most efficient way of providing health care to all, not the fastest way to drain the NHS of funds. If NHS money is better spent caring for people in their own homes than in hospital beds in large general hospitals, that is what should be done. If the money is better spent on specialist units, that is what should be done, and if the money is better spent on an expanded and improved accident and emergency department at Tameside general hospital, that is what should be done—and that is what is being done.
	A modern NHS requires a range of different services to provide the best care. If money is taken away from one service, it is not being cut or disappearing. It is being channelled towards a service that is better for more patients. The NHS survives through reform and investment. British society has changed immeasurably. We are living longer, becoming more demanding and expect state-of-the-art treatments when it is convenient for us, and rightly so. The people have not, however, changed their minds about the NHS. My constituents want the NHS. They want the first class state-of-the-art treatments that will soon be provided by the new£80 million investment at Tameside and by the new facilities at Stepping Hill, but they also want the freedom to choose when they want that treatment and whether they would rather stay in hospital or recover, supported by medical practitioners, in their own home. Many of my constituents are not the wealthiest people in Britain—far from it—but they deserve the best possible treatment.
	The history of my Greater Manchester constituency is one of change. Denton was famous for making hats. Huge swathes of the population of Denton and Stockport were involved in hat manufacturing, as well as other textile and heavy industries. Today, the people of Denton and Reddish lead different lives, so the NHS must continue to find new ways to make itself accessible to people with varied lifestyles. It has been argued by many that the importance of choice in health care is exaggerated. No; choice in health care is not like choice in shopping—it is much more important than that.
	Many people in my constituency—often those in the most deprived areas—are not sufficiently connected with doctors and nurses. Those connections must be strengthened for the sake of both my constituents' health and the efficiency of health provision. If my constituents, some of whom are trying to hold down two or three part-time jobs, cannot choose when and where they and their families access health care, their quality of health and NHS money will be wasted. If a range of times and locations are not available to those in need of treatment and advice, appointments will be missed. When that happens, treatments and advice are not given, medical practitioners are not able to understand further their patients' needs and public money is wasted. Without more freedom, many of my most vulnerable constituents will not access health care and health advice.
	The health profile of England maps, which were published yesterday, show the problems that we still face, and I am well aware that my constituents face them every day. Like many northern areas of England, Denton and Reddish has higher obesity rates, more smoking-related deaths and, consequently, lower life expectancies than the English average. Men can expect to live for 74 years and women 79 years, but both figures are lower than the national and regional averages. The goal for the NHS should be to make it as easy as possible for those in need to receive the advice and treatment that they need to the end the health divide.
	Under the Tories, the funding for hospitals was skewed towards richer areas, which embedded inequalities. The Labour Government are reforming the system because we believe that the divide is unacceptable. Since my election, I have worked hard in my constituency to ensure that our local PCT and acute services are reforming their provision of care. The Labour record on expanding NHS capacity should not be in doubt. Labour health reforms have been, and will continue to be, changes for the better.

Tony Baldry: Various things have happened in the NHS in the past year. The crisis involving deficits affected many NHS trusts and demonstrated itself through the closure of many community hospitals, or, in my constituency, the non-opening of a new community hospital, which the right hon. Member for Darlington (Mr. Milburn) had promised from the Dispatch Box when he was a Health Minister. He said that we would have a new and enlarged community hospital in Bicester, but that has not happened and clearly will not now happen. The Secretary of State's speech gave us no explanation of why the Government have suddenly turned their back on community hospitals.
	We are now moving towards another trend of downgrading so many services in smaller general hospitals that they effectively cease to be general hospitals. Such a thing is proposed and threatened for the Horton general hospital in Banbury. The hospital serves a large catchment area—much of south Northamptonshire, much of south Warwickshire and west Oxfordshire—which is why today my right hon. Friend the Member for Witney (Mr. Cameron), my hon. Friends the Members for Stratford-on-Avon (Mr. Maples) and for Daventry (Mr. Boswell) and I have submitted a joint observation to the Oxford Radcliffe Hospitals NHS Trust. If hon. Members want to read it in full, it can be found at www.save-our-services.com. The important point is that we say:
	"We believe that the Oxford Radcliffe NHS Trust, the Strategic Health Authority and the Government should be seeking to ensure that we can keep the Horton as a General Hospital delivering all the clinical and medical services that one would reasonably expect a local General Hospital to deliver",
	which seems not unreasonable.
	The tragedy about the proposals is that they are not a consequence of the trust saving particularly large sums of money. In fact, over a full year, the trust would save only some £1 million to £1.3 million, which is between 0.25 to 0.5 per cent. of the total Oxford Radcliffe Hospitals NHS Trust budget. If the trust, the strategic health authority and the Government had the will, they could find those savings elsewhere in the trust budget without leading to a significant downgrading of services at Horton general hospital—a downgrading that will have a major impact on local people.
	The downgrading starts with the downgrading of paediatric services. The sadness of the matter is that long ago in 1974 a young boy from Bloxham, a village just outside Banbury, died. The then Secretary of State, Barbara Castle, ordered an independent inquiry that found that there should be 24/7 paediatric services at Horton general hospital to serve the wider catchment area. Under the proposals, we will effectively go back 30 years to the period before Barbara Castle's decision. The knock-on effect of not providing 24/7 paediatric services is that one can no longer provide obstetric services, because there is no special care baby unit, yet we are proposing to set up the largest midwife-led maternity unit in the country.
	The consequence of the proposals is that 58 GPs—I hope that the House takes note of that number—have collectively made a submission to the Oxford Radcliffe Hospitals NHS Trust, in which they say in excoriating terms that the proposals are unsafe and inhumane. The GPs make excoriating criticism, too, about the fact that the consultation has been carried out with total disregard for any medical or professional consideration:
	"Local services for children are the key issue around which many other services hinge. They have a significant impact on the viability of other hospital departments especially maternity and accident and emergency.
	It is evident that paediatric emergencies such as meningitis, septicaemia, respiratory distress, and serious poisoning may all incur dangerous delay in receiving appropriate care if the nearest paediatric department is an hour away.
	Serious, life-threatening illnesses do not confine themselves on the working day."
	On maternity services, the GPs say that
	"under the proposals, mothers who required unexpected medical care during birth would need rapid transfer to Oxford...This would carry significant risk and would be inhumane."
	Even on the trust's own figures, a very large number of mothers who elected to have their babies at the Horton hospital would have to move to the John Radcliffe hospital in Oxford during labour. That is wholly unacceptable in the 21st century.
	The issue is of concern to all political parties locally. Indeed, the "Keep the Horton general" campaign, under the excellent leadership of local Labour councillor George Parish, is supported by people from every single political party. Thousands of people marched through Banbury and rallied in the local parks in support of the issue, which is a completely cross-party concern. It is not surprising that, without dissent, Cherwell district council, said:
	"The proposals in the consultation document potentially put patients at risk, fail to deliver the aims of the ORHT"—
	that is, the Oxford Radcliffe Hospitals NHS Trust—
	"are contrary to current Government Policy, place an unnecessary cost burden on the local population and in no way meet the needs of the local community now or in the future, as such they are wholly unacceptable to this Council."
	They are also wholly unacceptable to the people whom the Horton general hospital has served for the past 150 years. Local people are determined to do everything they can to ensure that the Horton hospital remains a general hospital.
	I also hope that Ministers will recognise that the Oxford Radcliffe Hospitals NHS Trust has failed to carry with it any medical opinion. GPs can speak publicly, and they have done so collectively. But another concern that I wish to draw to the attention of the House is that many of those who work for the trust have felt unable to speak openly because of potential disciplinary and other pressures. During the summer I had a number of meetings with consultant specialists at the Horton and the trust, but they wanted to have them away from the hospital, and in private. I asked them, "Why on earth are you unwilling to speak on the record?" They replied that they feel that they would be discriminated against as a consequence. That is wholly unacceptable. The last time I had meetings of that kind was when I talked with dissidents in eastern Europe before the fall of the Berlin wall. That should not be happening when people are talking about reorganisation of general hospitals in the 21st century.
	The proposals will lead to the downgrading of an excellent general hospital to such an extent that it will no longer be a general hospital in the way that people understand what a general hospital is; it will be merely a collection of medical services. The proposals are completely friendless and completely unsupported by medical opinion locally.
	I very much hope that in due course the overview and scrutiny committee of Oxfordshire county council refers the proposals to the Secretary of State, and I hope that the very least that the Secretary of State will do is refer them to the Independent Reconfiguration Panel. But I would also hope that before then Ministers will have the nous to wake up to the fact that 58 GPs are opposed to the proposals; there is not a single dissenting GP in the entire area served by the Horton general hospital—there is not a single voice supporting the proposals. In the face of such widespread medical opposition, it might be sensible for the Department to intervene, and to suggest to the Oxford Radcliffe Hospitals NHS Trust that it should think again about this matter and seek to ensure that we keep the Horton general a general hospital.

Madam Deputy Speaker: Order. I should remind the hon. Lady that I just sit in the Chair; this is nothing to do with me. The parliamentary term that she wants is "Opposition Members".

Roberta Blackman-Woods: I hope that the hon. Gentleman accepts that the situation varies across the country and has a great deal to do with how effectively resources are managed. I will give him an example. The acute trust in Durham is considering how it can reduce some of the acute services where there is overcapacity and shift those resources towards primary care services. I hope that that will lead to better treatment services in local communities—that is what has to happen. It is a difficult decision, and I have had to argue for it locally because the local press and opposition are trying to make out that that means cuts. It does not; it is about planning for the future and reconfiguring according to need. We on the Labour Benches have started a very important debate.
	Given that the Conservatives called today's debate, I thought that I would look at their website to see what policies they are producing to address the issues. I consulted "The Wellbeing of the Nation", a public service improvement policy group publication from Autumn 2006. I hope that that is recent enough for Conservative Members. The first thing that I discovered was
	"Policy-makers—of all parties"
	apparently
	"have too often fallen into the trap of implying that employment in the professions is 'just another job'. We believe this approach fatally undervalues"
	the professions working in the health service. That may be the Conservatives' belief, but it is most certainly not the belief of those on the Labour Benches. We have always valued people who work in the national health service, and I pay tribute to those who do so in my constituency.
	I also looked at the Leader of the Opposition's weblog, where he tells us about news of the health service and that reorganisation in the health service must stop, with which I agree with him—we need a period of stability. However, the very first point in the document says:
	"Are the present structures within the clinical professions capable of performing the roles..? If not"
	should they be amended? It continues:
	"Are the present structures within the NHS capable of performing the roles envisaged...in this partnership?"
	If not, it asks, should there be amendments?
	Conservative Members are not even addressing the challenges that they are setting for themselves. I would like to hear from them how they will achieve the move from acute to primary services. How will they deal with rising expectations? How will they keep the NHS safe if they commission from the independent sector? We have heard it acknowledged this afternoon that all services could be commissioned from the independent sector. How would the NHS be safe with them? My constituents know from their experience that the NHS is safe with us, not with the Conservative party.

Graham Stuart: No—I have only five minutes and hon. Members are stretching credulity if they think I will give way.
	There is more to life than economics, however, and the British people wanted world-class public services, not just a world-class economy. Labour's victory in 1997 was achieved on the basis that a Labour Government would accept Conservative economic prescriptions but use that economic strength to make our education and health systems world class, too. As my right hon. Friend the Member for Charnwood (Mr. Dorrell) said, it is greatly to the Labour party's credit that it reflected public opinion and the public's desire for world-class public services—a desire for spending to increase to the European average. The measures taken at that time were opposed by the Conservatives, but my party has listened to the British people and recognised the need to change, and it is doing so.
	There has been a doubling—not a trebling, as one hon. Member said—of spending on the NHS in real terms since Labour came to power. Sadly, however, outputs and the outcomes for patients have not matched the massive increases in resources. In the 1997 manifesto, Labour promised to be
	"wise spenders, not big spenders",
	but Ministers admit—even the Secretary of State has done so, albeit not today in her rather weak speech, which did not match the strength of many Labour Members' contributions—that outputs have not increased in line with increases in resources.
	We have heard a great deal about acute hospital performance. In the six years to 1997, the number of hospital treatments in the NHS increased by 26 per cent. Productivity was improving sharply during the 1990s.  [ Interruption. ] If the hon. Member for North Durham (Mr. Jones) will allow me, I am trying to address the root of the problem. There is a consensus about the broad approach, and we as a Parliament and as politicians need to work together to find a way forward. In the six years after 1997, however, there was only a 14 per cent. increase in hospital treatments, and according to the Office for National Statistics, productivity in the NHS has fallen by up to 1.3 per cent. each year since 1997.
	Labour Members can take credit for the massively increased expenditure on the NHS, and there have been improvements in standards as a result of that investment; those points are valid and they deserve to be made. However, falling productivity means that that expenditure has not brought value for money for the UK public. The Secretary of State for Health said earlier this year
	""For all the extra money, all the extra staff and extra patients treated, NHS productivity has remained almost unmoved."
	The truth is that it has moved: NHS productivity has fallen under Labour. That is the central problem.
	I and many of my colleagues broadly support the vision set out in the White Paper at the beginning of this year. It is the disconnection between that vision and the reality on the ground that we are discussing today. Ways must be found to address the problem of falling productivity that has been recorded under the Government and to overcome it. I hope the Government will be able to make improvements. Although that will be less politically advantageous to us at the next election, I hope there will be serious productivity improvements by then.

Graham Stuart: I will not take any interventions, after the words of the Deputy Speaker.
	If the Government had merely maintained the progress—admittedly, with much lower resources—of the last Conservative Administration, 1.4 million more people would have received hospital treatment under the Labour Government. Waiting lists, instead of being massaged, would have been banished. The hon. Member for Bedford described the financial arrangements of the NHS as bizarre, confusing and damaging and said that the resource accounting and budgeting must be sorted out.
	Labour has failed because it has not delivered value for money. For all the billions that have been spent,1 million people still remain on waiting lists, which none of us in the House wants to see. Health inequalities have been mentioned several times. I do not want to be rude to Labour Members, but there seems to be a certain level of complacency about the fact that health inequalities are at their widest since Victorian times and 10 community hospitals have closed in the first six months of this year alone.  [Interruption.]
	The debate is very much about staff. My colleagues are urging me on. I thought they were urging me on in my speech, but I now realise that they are urging me to stop so that they can speak, so I shall conclude, in deference to them, with a letter that was delivered to the Prime Minister two days ago. It is signed by the general secretary of the Royal College of Nursing, the chief executive of Diabetes UK, the chief executive of the National Rheumatoid Arthritis Society, the chief executive of the MS Trust and the executive director of Incontact—who, I hope Labour Members will accept, are not a group of Tory stooges trying to make political advantage for its own sake. The letter states:
	"Now the very people who have delivered your reforms are among the thousands of NHS staff who are at risk of redundancy. A culture of fear and uncertainty has permeated the health service. Nursing staff are worried about their futures and have become increasingly concerned about the safety and welfare of their patients, whom we believe are at serious risk from the actions which Trusts in deficit are taking to save money."
	That is the position that we are in. We all need to work together to sort it out. Moves to stop the meddling from the centre and to provide an independent board for the NHS—the prescription proposed by the Conservative party—will make the difference. We will work with the Government while they remain in office to try and improve the NHS. I hope all sides will work together on it.

Martin Horwood: Cheltenham and Tewkesbury primary care trust had also never had a deficit, but it has not saved us from the cuts. The fiction that they affect only a minority of trusts is nothing to do with the configuration of the deficits. Shared services and other factors are causing that.

Anne Milton: My hon. Friend is right. Significant research suggests that rural areas, and areas with a high percentage of elderly people, are underfunded.
	The Government can act now and stop this. The way that I see it, hospital staff, the public and the Government are on a collision course, which is starting in Surrey and Sussex. The new chief executive of the NHS made it absolutely clear that he wants to see60 acute trusts close. He wants more care delivered in people's homes, and that aim and vision is not inappropriate but, as ever, the closures will happen before the investment is put in. In a place such as Surrey, and for my constituents in Guildford, travelling times to accident and emergency could increase to as much as 70 minutes.
	It would be awfully nice if the Secretary of State listened to me for a minute and took some notice of what is going on. Clinicians, GPs and respected hospital doctors have told me that people will die if our accident and emergency departments are closed. The chief executive of the strategic health authority has said time and again that four out of five people can be treated outside A and E, but I still await an answer from the chief executive as to whom those four out of five people are. I contend that this Government will put lives at risk if they continue in their determination to close A and E departments and to downgrade our acute trusts, which also add to the huge research base in this country.

Martin Horwood: I begin by declaring an interest. My wife works in my local NHS, so I must take particular care to praise the work and endless patience of local NHS staff, including those in the former Cheltenham and Tewkesbury PCT. The people there, just like their counterparts in the constituency of the hon. Member for Hackney, South and Shoreditch (Meg Hillier), did everything that the Government asked of them. They never had a deficit, with the result that the PCT was top-sliced. It was given a promise that it would get its cash back, but it has now been abolished. I hope that the new Gloucestershire PCT will do as well and survive longer. To be fair, I would also like to praise the extra investment that has gone into the NHS, which we supported. However, I have to acknowledge that, as the right hon. and learned Member for Rushcliffe (Mr. Clarke) said, most of the reasons for the current crisis lie in the mismanagement of that extra NHS finance at a national level, including things such as the over-commitment on GP and consultant contracts.
	The cuts and closures in Cheltenham are very serious. We face the loss of local adult mental health services; cuts in acute care; the decision to close a local rehabilitation hospital before any plan for providing those services elsewhere has been put in place; cuts in health visitors, community nursing, community dental services, patient transport and the prescription of drugs newly approved by the National Institute for Health and Clinical Excellence; and the loss of overnight acute in-patient child care, despite the promise one year ago that that would be saved, at least as a nurse-led unit. The consultation process that we have just been through made no difference to any of those things.
	One service has been partially salvaged from the wreckage. After 15,000 signatures and 10,000 people marching through the streets of Cheltenham, St. Paul's maternity unit has been saved—at least as a midwife-led unit. Let us hope that that promise sticks. However, most of our local maternity service—probably some 2,000 deliveries a year—will be lost and people will have to travel to Gloucester. The Government have even had the bare-faced cheek to claim public support for that policy. The health White Paper said:
	"participants in the  Your health, your care, your say consultation said they wanted more care provided in community settings. The majority favoured increased investment in the latter, even if this meant changing the type and scale of services provided by their local hospital."
	Well, that is not quite what was said. On the same page of the White Paper, the citizens' summit consultation is quoted. The following question was asked:
	"To what extent do you support or oppose providing more services closer to home, including community hospitals, if this means that some larger hospitals concentrate on specialist services and some merge or close?"
	Only 15 per cent. of the people at the summit supported that in an unqualified way; 39 per cent. supported it to some extent. To find out which bits people supported, and what they were hesitating about, we have to go back to the consultation document "Your health, your care, your say". Buried on page 112 of that document is the summary of the main findings of the consultation. The summary makes it clear that
	"Most support moving hospital services into the community"
	because
	"They think services will be more accessible, because they are nearer to home".
	What were people hesitating about? They were quite clear. I quote from the Government's own document:
	"They think the Government is proposing to close hospitals via the 'back door'".
	Let us consider the kind of journeys that were supposed to be avoided by providing services closer to home. "Your health, your care, your say" provides me with a local example. On page 114, it says:
	"One participant gave the example of travelling from Cheltenham to Gloucester for treatment: a one-way taxi for that journey costs £35."
	That participant must be absolutely staggered by what is happening in Cheltenham. As part of the reconfiguration of services, obstetrician-led maternity care will cease, sending, as I said, some 2,000 expectant mothers on exactly the journey from Cheltenham to Gloucester that "Your health, your care, your say" said we would be avoiding. They will be making that journey along with their relatives and friends, the sick children going to the new overnight children's care service in Gloucester, the mental health patients going to the new adult mental health services at Wootton Lawn in Gloucester, and many others. It is quite clear that, although Labour was elected to save the NHS, what it is delivering for my constituents and many others across the country is less choice, not more, and health care further from home, not closer to home, and it is claiming support for both, when that support never existed.

Crispin Blunt: May I say what a pleasure it is to see the Secretary of State grace the end of the debate in such sartorially elegant fashion? I wish that I could be as gallant about what she has done to hospital provision in my Reigate constituency, but I am afraid that I cannot.
	The debate has been characterised by a remarkable contrast. A number of Government Members have said how splendid things are in their constituency and how cross they are about the prospect of their budgets being put at risk so that deficits can be dealt with—deficits that, by a remarkable coincidence, seem to be in trusts represented by Conservative Members. It is beyond belief that all the incompetent NHS managers have ended up in Conservative constituencies, while all the brilliant managers have somehow ended up in Labour constituencies. The principal acute trust in my constituency—Surrey and Sussex Healthcare NHS Trust—is about to appoint its seventh chief executive since 1997. It may be the sixth chief executive—I may be one out, as it is easy to lose count.
	I shall speak in strong support of the proposals that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and my right hon. Friend the Member for Witney (Mr. Cameron) and made about the independence of the health service. The speech of the hon. Member for Waveney (Mr. Blizzard) was instructive. He wanted the ability to interfere politically in the provision of health care in his constituency. What happened in my constituency is nothing short of a disgrace. On 19 December last year, the Secretary of State overturned a recommendation for a new hospital in Sutton in favour of a new hospital at St. Helier, at the explicit request of her hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) solely on the basis of evidence provided by the hon. Lady.
	Earlier in our debate, the Secretary of State told us that she took that decision on the basis of health inequalities. The only problem with that explanation is that she received advice that directly contradicts that explanation from her own adviser on the NHS in London, Dr. Sue Atkinson, on health inequalities and the merits of that decision. Dr. Atkinson's advice to the Secretary of State was unequivocal:
	"I recommend that you should therefore accept the judgment of the local NHS on the location of the Critical Care Hospital...to be at Sutton."
	The hon. Member for Wyre Forest (Dr. Taylor) made the point that decisions in which the Secretary of State had intervened had not been referred to the independent reconfiguration panel, and nor was the decision in my area. I have to tell the hon. Gentleman that there is a case for independent review when the Secretary of State intends to overrule the decision of the local health community. If the Secretary of State is minded to accept a recommendation—in this case, the unanimous decision of the local medical establishment that a new hospital at Sutton was the right decision—I do not think that there is a case for the Secretary of State to go to the independent reconfiguration panel.
	The Secretary of State's decision was so outrageous that Reigate and Banstead borough council and Surrey county council decided, having taken counsel's advice, to seek judicial review of that decision because it was unreasonable. The first stage of the process was complete, a case to answer was identified and a court date had been set, but on 16 August the Secretary of State reversed her decision, pending another review. That is one of the cover-ups that always goes on when there has been political interference. That case was direct political interference in the interests of the Labour party in Mitcham and Morden: I can say that because the Government have form, as the same thing happened at the southern end of my constituency. I notice that the hon. Member for Crawley (Laura Moffatt) is present. We have had this debate on numerous occasions and I will not repeat it now, except to say that one month before the 2001 general election, the Secretary of State directly interfered, at the request of the hon. Member for Crawley, to affect a decision in the political interests of the Labour party in Crawley.
	The hon. Lady has defended herself, saying that she will go on intervening to defend her constituents' interests. I know, as well as she does, that what she did was not in the interests of her constituents or of all the people who were being provided with acute hospital care in the area. It was not the right decision, and it has taken another four or five years for Crawley hospital to be extracted from the provision of acute care by the acute hospital trust. I am delighted that it is now the responsibility of the hon. Lady's local primary care trust, and it is now out of the hair of the managers who are trying to provide acute hospital care.

Grant Shapps: I am grateful to be speaking at the end of what has been a very interesting debate, characterised by Labour Members telling us that everything is well, and Opposition Members pointing out problems. As ever, the truth probably lies somewhere in between. However, the specific subject of the debate is staff cuts and the surrounding financial environment, on which I wish to touch briefly.
	There are many different ways in which the constraints on the health service are impacting on the way that it is run. I am very pleased that the Secretary of State is in her seat, so that I can mention one of them. Sterilisation of instruments is increasingly being centralised and as that is happening, operations are being cancelled, which is decreasing the efficiency of the health service. Next Monday, a report will be published showing a 21 per cent. increase in the number of operations cancelled, purely as a result of the centralisation of sterilisation of instruments used in operations.
	I have a letter from a constituent who said that last week, she was in the Queen Elizabeth II hospital in Welwyn Garden City waiting for her operation. She came in the day before, so she used a hospital bed, in which she was put up overnight. A high-dependency bed was booked for her the day after her operation. She spent the entire day in the waiting room—the anteroom, as she calls it—awaiting surgery, only to be told that the operating implements were dirty and that no more could be obtained in time.
	It was not only my constituent's operation that was cancelled that day; 10 others were also cancelled. Surely it cannot be long—it has probably already happened in the QEII hospital and elsewhere where centralisation is taking place—before somebody is on the operating table and is cut open, only for it to be found that an instrument of a different size or nature is required to finish the task. I know that that happens in operations—I once had my clavicle operated on, and exactly that happened. If no instruments are available, the person has to be sewn back together and told to come back another day. I tell the Secretary of State that that is an unacceptable situation, which is a direct consequence of the financial crisis that we are experiencing.
	Another fact, sourced through a freedom of information request, is that there has been a 40 per cent. increase in the number of operations cancelled merely for administrative reasons, because, for example, the operating theatre had not been booked or the patient's notes not sent—even because the patient had not been told that the operation would be taking place. In a period of only three years, a 40 per cent. increase in cancelled operations for such reasons is of real concern.
	I would appreciate the Secretary of State taking this point on board: 640 operations are cancelled every day, simply due to administrative cock-up—640 throughout the NHS. That is a huge figure. On Monday, I shall be supplying her with the figures, so that she can see for herself. They have been obtained from all the hospital trusts through the freedom of information procedure, and I shall be interested to know what action the right hon. Lady intends to take.
	Time is short, so I shall conclude by mentioning Hatfield hospital. The Secretary of State will be aware that her predecessor visited Hatfield before the election when a Health Minister held my seat with a dodgy majority. The then Secretary of State for Health promised us a £0.5 billion new private finance initiative hospital at Hatfield. What happened? When I defeated the incumbent Labour Health Minister, the plan for that hospital disappeared—[ Interruption.] If I am wrong I shall be interested to hear the Secretary of State's response.
	Not only has that shiny new £0.5 billion hospital plan gone, but the existing Queen Elizabeth II hospital in Welwyn Garden City, which is supposed to support all the present population plus an expanded population, because we are told that we need to build tens of thousands of new homes, is being chopped away bit by bit. We are about to lose A and E, maternity, paediatrics and much more besides. That simply does not add up. I ask the Secretary of State to respond when she has the opportunity and I hope that she will take these matters more seriously than some of her Back Benchers, who have been laughing them off all afternoon.

James Gray: When the hon. Member for Hackney, South and Shoreditch (Meg Hillier) spoke, she was very content about the fact that her PCT was breaking even. However, she failed to mention one vital fact: every person in Hackney has £2,000 a year spent on them. In the Prime Minister's constituency, the amount is £1,300 a year and the average for England is £1,200, while in my constituency the average is only £900 a year. It isthus hardly surprising to discover that my PCT is£43 million in deficit across the SHA and that, as a result, health provision in North Wiltshire is in a deep and damaging crisis.
	It was tragic to drive past Malmesbury hospital the other day and see the barriers behind which it was being demolished. It is tragic to hear that maternity services at Chippenham are so badly underfunded that there are no staff, so the services can no longer be provided. It is tragic that according to a consultation paper currently out for consideration up to seven community hospitals across the county of Wiltshire could be closed. It is tragic that the Royal United hospital in Bath, which serves my constituency, is laying off about 300 people and closing 60 beds, and that the Great Western hospital in Swindon is laying off 198 people.
	When we put all those facts alongside the failure to provide dentistry and proper GP services in parts of my rural constituency, they amount to a significant crisis in health care in North Wiltshire. Whether that is the fault of the Labour party, senior managers or me, I know not, but I can tell the Secretary of State one thing in the few moments remaining for my speech: if she thinks that the NHS is having its best-ever year, I challenge her to visit North Wiltshire and see what I see in my constituency surgery every Saturday. Let her go to Malmesbury hospital, now being destroyed, to Chippenham hospital where destruction is imminent and to the seven hospitals in my area that are threatened with closure and then tell me that all is well with the health service in Wiltshire.

Stephen O'Brien: After a full day's debate in Opposition time, we have covered an enormous range of issues on the NHS, with particular focus on the NHS work force. I hope that the Minister of State, the hon. Member for Leigh (Andy Burnham), and I can do something novel and avoid the ritual ding-dong that tends to happen on these occasions. The Minister gets the last word, so if I refrain from the ding, it is no guarantee that he will refrain from the dong.
	The temptation is to revert, as always, to the tired old slanging match of me pointing out the failures and disappointments of the Government's policies on the NHS and the Minister reading out his prepared false accusations to the effect that we want to take money out of the NHS, when we are clearly committed to precisely the opposite. My right hon. Friend the Leader of the Opposition confirmed that only two days ago when he said that all parties supported increased NHS funding. It is worth taking the risk and seeing whether the Minister will respond to the genuine concerns and worries that have been raised in our important and timely debate.
	Our debate on the vital issue of our NHS work force was ably opened by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). I am confident that I speak for the whole House when I pay tribute to all the medical professionals—the nurses, the therapists and practitioners in our NHS. As my hon. Friend said, they do excellent work on which we all rely—my family no less than any other, as we have very good reason to be eternally grateful to NHS professionals and carers.
	After my hon. Friend's excellent opening speech, we heard from the Chairman of the Select Committee, the right hon. Member for Rother Valley (Mr. Barron), who called for more evidence to build on some of the anecdotal points. I do not see him in his place, but he rather uncharacteristically spent his time hair splitting and on the semantics of whether we are talking about "posts" or "jobs" in the NHS.
	Our debate is more likely to be remembered for the outstanding contributions of two former Secretaries of State for Health, my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) and my right hon. Friend the Member for Charnwood (Mr. Dorrell). My right hon. and learned Friend the Member for Rushcliffe rightly said that there was a remarkable consensus about the partnership approach that we all adopt to supporting the NHS. He also rightly argued that, because of some of the Government's actions and despite good will, we are in danger of seeing reform being given a bad name, when we need the money and reform to ride together. He was particularly concerned about the short-term expediency forced on so many NHS organisations through financial pressures and cuts. His major point was that those factors are unlikely to lead to greater efficiencies, so productivity is damaged—a point strongly reinforced by my right hon. Friend the Member for Charnwood when he said that a once in a lifetime chance to reform the NHS and its productivity had been fluffed. He argued that it was important to challenge moves to take resources out of community services, which represent an easy hit for a Government attempting to correct financial incompetence.
	Those two remarkable speeches were followed by that of the hon. Member for Pendle (Mr. Prentice), who reminded us—more a revelation than a reminder for Opposition Members—that at the parliamentary Labour party meeting on Monday, the Prime Minister had urged Labour MPs to attack Conservatives on the so-called "marketisation agenda", as the Prime Minister is alleged to have put it. The hon. Member for Pendle thought, "Goodness me", recognising that that seemed to be the pot calling the kettle black. Moreover, he then said that the Government had Maoist tendencies in pursuing a ceaseless recovery and reorganisation programme.
	My right hon. and hon. Friends made many good speeches. My right hon. Friend the Member for East Hampshire (Mr. Mates) spoke about the importance of continuing commitment to our community hospitals and my hon. Friend the Member for Mid-Sussex (Mr. Soames) coupled praise for local NHS staff with concern for the future of medical provision in his area.
	My hon. Friend the Member for West Chelmsford (Mr. Burns) made a very powerful and balanced speech about delay to a new facility, despite all the promises that had gone before, and the necessary closure of an organisation—something that he supported, so long as it was replaced by another—and about the disappointment that has attended the process. The speech that followed was a plea by my hon. Friendthe Member for Banbury (Tony Baldry) not to downgrade the Horton general district hospital in his constituency.
	Many Labour Members spoke, but it would take up too much time to recite the points that they were seeking to make. However, it was a question of deciding at what point in the 10 minutes allocated to all Back-Bench Members that the rose-tinted spectacles fell and the word "but" was used to launch the plea that they wanted to make about their own constituencies to try to stop the Government doing what they were about to do, or to ask the Government to do something that they had already indicated that they were not prepared to do. That was quite characteristic and particularly notable in the speech of the hon. Member for Bedford (Patrick Hall). However, it is fair to say that there were some honourable exceptions, not least the hon. Member for Pendle, but also the hon. Member for Northampton, North (Ms Keeble), who spoke quite late in the debate and made a constructive set of criticisms, to which I hope Ministers were listening carefully.

Andy Burnham: I will not give way as I have not much time.
	The hon. Member for Northavon raised questions about independent sector treatment centres. May I point out that we pay significantly less for operations done through the private sector using this system than the extra premium that was paid in the past? He mentioned physios, as did many others, and there are genuine issues there. We are working with the Chartered Society of Physiotherapy to address these matters. We have removed physiotherapy from the list of shortage occupations for work permits and are working with NHS employers to make more junior posts available. However, I take his point on that.
	The hon. Member for Wyre Forest (Dr. Taylor) made a measured and important speech. He more than anybody knows the interplay between the NHS and politics and the important issues that that raises. He congratulated my right hon. Friend the Secretary of State on the referral of more cases to the independent reconfiguration panel and he had important things to say about urgent care and the delivery of urgent medicine without necessarily having to have the back-up of other acute facilities. I look forward to hearing how his meeting with the NHS chief executive goes.
	The hon. Gentleman made points about the private sector, as did my hon. Friend the Member for Pendle (Mr. Prentice). I assume that the hon. Gentleman's constituents are like mine and want 18-week maximum waits for treatment from the end of 2008. I also assume that he does not want stranded NHS capacity all round the country once we have met that target, so I hope that he will take on board that, when it is sensible to use the private sector to help the NHS, we will continue todo so.
	My right hon. Friend the Member for Rother Valley (Mr. Barron) authoritatively demolished the Tory campaign pack that was mentioned in the debate. He shredded the figure of 20,000 job losses. People can draw their own conclusions, but it is dangerous information that the Tories are seeking to put into the public domain. My hon. Friends the Members for Dudley, North (Mr. Austin) and for Burnley (Kitty Ussher) did a forensic analysis of Tory health policy and the dissembling statements from the Conservative party. They tore them to pieces.
	My hon. Friend the Members for Wigan (Mr. Turner), for Hackney, South and Shoreditch (Meg Hillier), for City of Durham (Dr. Blackman-Woods) and for Kingston upon Hull, North (Ms Johnson) made excellent speeches and powerful arguments against the moving of funding away from the parts of the country that have the most severe health inequalities, as has been advocated in the Opposition's policy document. I am sure that the whole House will have heard their comments.
	My hon. Friend the Member for Waveney (Mr. Blizzard) was in the middle of praising the James Paget hospital when there was an astonishing moment. The hon. Member for West Chelmsford (Mr. Burns), for whom I have great respect, intervened to ask my hon. Friend to comment on a rumour about a hospital being scheduled for closure. My hon. Friend batted it away, but we have seen a new political tactic of circulating rumours about hospitals, even on the Floor of this House.

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	 Question, That the Question be now put,  put and agreed to.
	 Question put, That the original words stand part of the Question:—
	 The House proceeded to a Division.

Patrick Cormack: The Minister really cannot get away with that one. I have listened to quite a lot on which I would have liked to have intervened, but the National Heritage Memorial Fund—I was one of those who helped to found it—started off with a budget that was much bigger than the one that it is going to have at the end of the year. Of course, we welcome the extra £5 million, but the figure is still£15 million less than the £25 million that it had. We should not led the Minister pretend that that is a success, because it is not.